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目的 探讨成年原发性肾病综合征(PNS)合并甲状腺功能(简称甲功)异常患者的临床特征及其相关性,以期通过临床资料早期鉴别可能合并甲功异常的高危成年PNS患者.方法 回顾性分析2015年3月至2017年12月长治医学院附属和济医院101例成年PNS患者的临床资料.将患者按甲功进行分组,甲功正常67例(甲功正常组);甲功异常34例(甲功异常组),其中低三碘甲状腺原氨酸(T3)综合征9例,亚临床甲状腺功能减退(甲减)25例.比较患者的临床资料,并分析促甲状腺激素(TSH)与24 h尿蛋白、血白蛋白和收缩压的相关性.结果 成年PNS患者甲功异常发生率为33.66％(34/101),其中膜性肾病21例,微小病变型肾病8例,IgA肾病4例,膜增生性肾炎1例.甲功异常组24h尿蛋白明显高于甲功正常组[(8.76±3.62)g比(6.96±3.43)g],白蛋白明显低于甲功正常组[(21.82±4.89) g/L比(24.49±4.14) g/L],差异有统计学意义(P＜0.05或＜0.01);两组性别构成、年龄、病程、收缩压、舒张压、体质量指数、血红蛋白、血小板、肌酐、胱抑素C、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、纤维蛋白原、补体C3、IgG、IgM、IgA、PNS类型和合并症比较差异无统计学意义(P＞0.05).亚组分析结果显示,甲功异常组亚临床甲减患者收缩压明显高于甲功正常组和甲功异常组低T3综合征患者[(148.16±18.09) mmHg(1 mmHg=0.133 kPa)比(139.55±18.77)和(127.78±16.81)mmHg],24 h尿蛋白明显高于甲功正常组[(9.00±3.64)g比(6.96±3.43)g],白蛋白明显低于甲功正常组[(21.71±5.26) g/L比(24.49±4.14) g/L],差异有统计学意义(P＜0.05).Pearson相关分析结果显示,TSH与24 h尿蛋白和收缩压无相关性(r=0.193和0.072,P=0.053和0.472);TSH与白蛋白呈负相关(r=-0.340,P=0.001).结论 成年PNS合并甲功异常患者,膜性肾病最多,微小病变型肾病次之;合并亚临床甲减的成年PNS患者收缩压明显高于甲功正常和低T3综合征患者.成年PNS患者血白蛋白越低,可能越容易合并甲功异常.“,”Objective To explore the clinical characteristics and correlation of adult primary nephrotic syndrome (PNS) with thyroid dysfunction,and early identify high-risk adult PNS patients with abnormal thyroid function by clinical data.Methods The clinical data of 101 adult PNS patients in Heji Hospital Affiliated to Changzhi Medical College from March 2015 to December 2017 were retrospectively analyzed.According to the thyroid function,the patients were divided into 2 groups:normal thyroid function group (67 cases) and thyroid dysfunction group (34 cases),including 9 cases with low triiodothyronine (T3) syndrome and 25 cases with subclinical hypothyroidism.The clinical data were compared,and the correlation between thyroid-stimulating hormone (TSH) and 24 h urinary protein,blood albumin and systolic blood pressure were analyzed.Results The incidence of thyroid dysfunction in adult PNS patients was 33.66％ (34/101),including 21 cases of membranous nephropathy,8 cases of minimal change disease,4 cases of IgA nephropathy and 1 case of membranoproliferative nephritis.The 24 h urinary protein in thyroid dysfunction group was significantly higher than that in normal thyroid function group:(8.76 ± 3.62) g vs.(6.96 ± 3.43) g,the albumin was significantly lower than that in normal thyroid function group:(21.82 ± 4.89) g/L vs.(24.49 ± 4.14) g/L,and there were statistical differences (P＜0.05 or ＜0.01);there was no significant difference in gender composition,age,course of disease,systolic blood pressure,diastolic blood pressure,body mass index,hemoglobin,platelet,creatinine,cystatin C,fasting blood glucose,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol (LDL-C),fibrinogen,complement C3,IgG,IgM,IgA,PNS types and comorbidities between 2 groups (P＞0.05).The results of subgroup analysis results showed that the systolic blood pressure in subclinical hypothyroidism patients of thyroid dysfunction group was significantly higher than that in normal thyroid function group and the low T3 syndrome patients of thyroid dysfunction group:(148.16 ± 18.09) mmHg (1 mmHg =0.133 kPa) vs.(139.55 ± 18.77) and (127.78 ± 16.81) mmHg,the 24 h urinary protein was significantly higher than that in normal thyroid function group:(9.00 ± 3.64) g vs.(6.96 ± 3.43) g,the albumin was significantly lower than that in normal thyroid function group:(21.71 ± 5.26) g/L vs.(24.49 ± 4.14) g/L,and there were statistical differences (P＜0.05).Pearson correlation analysis result showed that TSH had no correlation with 24 h urinary protein and systolic blood pressure (r =0.193 and 0.072,P =0.053 and 0.472);however TSH was negatively correlated with albumin (r =-0.340,P =0.001).Conelusions In adult PNS patients with thyroid dysfunction,membranous nephropathy is the most common,followed by minimal change disease.The systolic blood pressure in PNS patients with subclinical hypothyroidism is significantly higher than that in patients with normal thyroid function and low T3 syndrome.In adult PNS patients,the lower the blood albumin is,the more likely they have thyroid dysfunction.