亚临床甲状腺功能减退症与2型糖尿病肾功能损伤的相关性研究

Correlation between subclinical hypothyroidism and renal function injury in patients with type 2 diabetes mellitus

目的了解2型糖尿病(T2DM)患者中亚临床甲状腺功能减退症(SCH)与糖尿病肾脏疾病(DKD)、肾功能损伤的相关关系。方法收集2017年9月至2018年8月在天津医科大学代谢病医院住院的656例T2DM患者,按是否合并DKD分为非DKD组(425例)和DKD组(231例)。比较2组间促甲状腺激素(TSH)水平、SCH患病率等指标差异。按TSH水平分为3组:TSH正常低值组(TSH<2.5 mIU/L,383例),TSH正常高值组(2.5 mIU/L≤TSH≤4.2 mIU/L,199例),SCH组(TSH>4.2 mIU/L,74例)。比较各组间大量白蛋白尿、DKD患病率、肾功能损伤指标等的差异,并对不同TSH水平与DKD的相关性行logistic回归分析。结果与非DKD组相比,DKD组TSH水平、SCH患病率均升高(Z=3.670,χ^2=12.978,P均<0.05)。与TSH正常低值组、TSH正常高值组相比,SCH组女性患者比例、大量白蛋白尿、DKD患病率、24 h尿蛋白定量水平均升高,估算的肾小球滤过率(eGFR)、FT4水平均降低(F=10.713~305.951,P均<0.05)。与TSH正常低值组相比,TSH正常高值组各指标差异均无统计学意义(P均>0.05)。Logistic回归分析显示,SCH与DKD独立相关(OR=2.187,95%CI:1.244~3.847,P<0.05)。结论T2DM患者中SCH与DKD、肾功能损伤密切相关。

Objective To investigate the correlation between subclinical hypothyroidism(SCH)and diabetic kidney disease(DKD),renal function injury in patients with type 2 diabetes mellitus(T2DM).Methods A total of 656 patients with T2DM in the Metabolic Disease Hospital of Tianjin Medical University were enrolled from September 2017 to August 2018and divided into non-DKD group(425 cases)and DKD group(231 cases)according to whether they merged DKD or not.The level of thyroid stimulating hormone(TSH)and the prevalence of SCH and so on were compared between two groups.All patients were divided into three groups according to their TSH levels:TSH normal low value group(TSH<2.5 mIU/L,n=383),TSH normal high value group(2.5 mIU/L≤TSH≤4.2 mIU/L,n=199)and SCH group(TSH>4.2 mIU/L,n=74).The prevalence of macroalbuminuria and DKD,injury markers of renal function and other indicators were compared among the three groups.The correlation between different levels of TSH and DKD was investigated by logistic regression analysis.Results Compared with non-DKD group,the level of thyroid stimulating hormone(TSH)and the prevalence of SCH were increased(Z=3.670,χ^2=12.978,all P<0.05)in DKD group.Compared with TSH normal low value group and TSH normal high value group,the proportion of female,prevalence of macroalbuminuria,prevalence of DKD and the level of 24-hour urinary protein were increased,whereas the estimated glomerular filtration rate(eGFR)and FT4 level were decreased in SCH group(F=10.713-305.951,all P<0.05).No significant differences were found between TSH normal low value group and TSH normal high value group(all P>0.05)for all of those indicators.Logistic regression analysis showed that SCH was independently correlated with DKD(OR=2.187,95%CI:1.244-3.847,P<0.05).Conclusion SCH is significantly correlated with DKD and renal function injury in patients with T2DM.