住院2型糖尿病患者甲状腺激素与慢性肾脏病检出率的关系

Relationship between the thyroid hormone and the detection rate of chronic kidney disease in hospitalized patients with type 2 diabetes mellitus

目的探讨住院2型糖尿病(T2DM)患者甲状腺激素与慢性肾脏病(CKD)检出率的关系。方法纳入于我科住院的T2DM患者1118例,根据是否合并CKD将其分为CKD组205例和非CKD(NCKD)组913例,收集两组患者的临床资料并进行比较。采用多因素logistic回归分析评估与CKD相关的危险因素。结果T2DM合并高血压患者中CKD检出率高于单纯T2DM患者(P<0.001)。CKD组患者年龄、高血压病程、T2DM病程、收缩压、舒张压、促甲状腺激素(TSH)水平均高于NCKD组,空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总三碘甲腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲腺原氨酸(FT3)及游离甲状腺素(FT4)水平均低于NCKD组(P<0.05)。多因素logistic回归分析结果显示,FT3、T2DM病程、FPG、低密度脂蛋白胆固醇(LDL-C)、收缩压与蛋白尿伴估算的肾小球滤过率(eGFR)下降独立相关;FT3、性别及收缩压与蛋白尿独立相关;TT4、FT3、T2DM病程、年龄、LDL-C、舒张压与eGFR下降独立相关;FT3为蛋白尿、eGFR下降及蛋白尿伴eGFR下降的独立危险因素(P均<0.05)。结论伴CKD的T2DM患者甲状腺激素水平与单纯T2DM患者不同,其中FT3是蛋白尿、eGFR下降及蛋白尿伴eGFR下降的独立危险因素,可能影响CKD的检出率。

Objective To investigate the relationship between thyroid hormones and the detection rate of chronic kidney disease(CKD)in hospitalized patients with type 2 diabetes mellitus(T2DM).Methods A total of 1 118 T2DM patients were included in our department.All patients were divided into CKD group and non chronic kidney disease(NCKD)group according to whether accompanied with CKD.General and clinical data of the two groups were collected and compared.Multivariate logistic regression analysis was used to study the risk factors related to CKD.Results The detection rate of CKD in T2DM+hypertension(HP)patients was higher than that in T2DM patients(P<0.001).The age,course of HP,course of T2DM,systolic blood pressure,diastolic blood pressure and the level of thyrotrophin(TSH)in CKD group were higher than those in NCKD group,the level of fasting glucose(FPG),glycosylatedhemoglobin(HbA1c),triiodinated thyroxine(TT3),free thyroxine(TT4),free triiodinated thyroxine(FT3)and free thyroxine(FT4)were lower than those in NCKD group(P<0.05).Multivariate logistic regression analysis showed that the level of FT3,course of T2DM,FPG,low density lipoprotein(LDL-C),systolic blood pressure were independently related to proteinuria accompanied estimated glomerular rate(eGFR)decrease,the level of FT3,gender and systolic blood pressure were independently related to proteinuria,the level of TT4,FT3,the course of T2DM,age,LDL-C and diastolic blood pressure were independently related to eGFR decrease,FT3 was an independent risk factor for proteinuria,eGFR decrease and proteinuria with eGFR decrease.Conclusion The levels of thyroid hormone in T2DM patients with CKD are different from those in T2DM patients.FT3 is an independent risk factor for proteinuria,eGFR decrease,and proteinuria with eGFR decrease,it may affect the detection rate of CKD.