不同分期的糖尿病肾病患者甲状腺功能的变化及其与亚临床甲状腺功能减退的相关性

The change and clinical significance of thyroid function and subclinical hypothyroidism in patients with different stages of diabetic nephropathy

目的探讨不同分期的糖尿病肾病(DN)患者甲状腺功能的变化及其与亚临床甲状腺功能减退的相关性。方法选取2型糖尿病(T2DM)患者200例,根据尿微量白蛋白/肌酐(ACR)将T2DM患者分为三组:正常尿蛋白组(NA组,n=72例)、微量白蛋白尿组(MA组,n=68例)和大量白蛋白尿组(OA组,n=60例)。比较每组亚临床甲减的发生率,分析亚临床甲减与不同分期DN的关系。结果与NA组相比,MA组和OA组TSH和亚临床甲减的发生率均升高,而FT3水平降低(P<0.05),OA组TSH和亚临床甲减的发生率均高于MA组,FT3水平低于MA组(P<0.05);ACR与TSH(r=0.301,P<0.001)呈正相关,与FT3呈负相关(r=-0.287,P=0.001);多元Logistic回归分析提示,校正一些危险因素如收缩压、糖尿病病程、HbA1c等,亚临床甲减仍然是MA(OR=1.995,95%CI 1.389~2.451,P=0.008)和OA(OR=2.313,95%CI 1.944~2.893,P=0.002)发生的独立危险因素;随着FT3水平的升高,NA的发生率逐渐升高,而MA和OA的发生率逐渐减低;随着TSH水平的升高,NA的发生率逐渐降低,而MA和OA的发生率逐渐升高。结论在不同分期DN患者中,亚临床甲减均是DN发生的独立危险因素。

Objective To investigate the change and clinical significance of thyroid function and subclinical hypothyroidism(SCH) in patients with different stages of diabetic nephropathy(DN).Methods 200 patients with type 2 diabetes mellitus(T2 DM) were enrolled.According to urinary microalbumin/creatinine(ACR),T2 DM patients were divided into three groups:the normal urinary albumin group(NA group,n=72),microalbuminuria group(MA group,n=68) and massive albuminuria group(OA group,n=60).The incidence of subclinical hypothyroidism in each group was compared and the relationship between subclinical hypothyroidism and DN in different stages was analyzed.Results Compared with the NA group,TSH levels and the incidences of subclinical hypothyroidism were higher while FT3 levels were lower(P<0.05).ACR was positively correlated with TSH(r=0.301,P<0.001) and negatively correlated with FT3(r=-0.287,P=0.001).Multiple Logistic regression analysis indicated that subclinical hypothyroidism was an independent risk factor for MA(OR=1.995,95%CI 1.389~2.451,P=0.008) and OA(OR=2.313,95%CI 1.944~2.893,P=0.002),after adjusting for risk factors such as systolic blood pressure,duration of diabetes,HbA1 c.The incidence of NA was increased while the incidences of MA and OA were decreased gradually with the increase of FT3 level.With the increase of TSH level,the incidence of NA was decreased,while the incidence of MA and OA were increased gradually.Conclusion Subclinical hypothyroidism is an independent risk factor for DN in patients with different stages of DN.