[终末期慢性肾功能衰竭患者的垂体功能紊乱]。

T N Markova, E V Kosova, N K Mishchenko
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摘要

肾脏功能紊乱会导致体内平衡失调。随着肾小球滤过率的降低,包括垂体激素在内的多种生物活性物质的新陈代谢也随之降低。本文概述了慢性肾脏病(CKD)患者垂体功能障碍的情况,并讨论了其发病机制的可能原因。文章特别关注对终末期慢性肾脏病(CKD)患者垂体激素浓度变化的评估,并讨论了其形成的病理机制。特别关注对接受肾脏替代疗法(RRT)患者垂体激素浓度变化的评估。慢性肾功能衰竭会导致催乳素、黄体生成素(LH)和促卵泡激素(FSH)水平升高。在这类患者中,生长激素(GH)、异胰岛素样生长因子-1(IGF-1)、促甲状腺激素(TSH)、促肾上腺皮质激素(ACTH)和血管加压素的浓度可能保持在正常值范围内或有所上升。RRT 不会降低催乳素、促肾上腺皮质激素和促肾上腺皮质激素的水平,而生长激素、IGF-1 和促甲状腺激素的浓度则趋于正常。促肾上腺皮质激素和血管加压素的含量可能保持不变或有所下降。在大多数情况下,肾移植可以纠正内分泌紊乱。纠正激素变化可以改善慢性肾脏病晚期患者的临床疗效和生活质量。
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[Pituitary disorders in patients with end-stage chronic renal failure].

Disorders in the kidneys lead to disturbance of homeostasis. As the glomerular filtration rate decreases, the metabolism of numerous biologically active substances, including pituitary hormones, decreases. The article presents an overview of pituitary dysfunction in patients with chronic kidney disease (CKD) and discusses the possible reasons of the pathogenetic mechanisms. Particular focus is being given to the assessment of changes in the concentration of pituitary hormones in patients with end-stage chronic kidney disease (CKD) and discusses the pathogenetic mechanisms of their formation. Particular attention is paid to the assessment of changes in the concentration of pituitary hormones in patients receiving renal replacement therapy (RRT). CKD leads to an increase in the level of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Concentrations of growth hormone (GH), isulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and vasopressin may remain within normal values or increase in this group of patients. RRT does not reduce the levels of prolactin, LH, FSH, while the concentration of growth hormone, IGF-1, TSH tends to normalize. The content of ACTH and vasopressin may remain unchanged or decrease. Kidney transplantation in most cases corrects hormonal disorders. Correction of hormonal changes can improve the clinical outcome and quality of life of patients with end stage CKD.

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