甲状腺激素水平对2型糖尿病肾脏病风险的预测

Prediction of thyroid hormone level on risk of type 2 diabetes nephropathy

目的研究表明甲状腺功能与慢性肾脏病(CKD)密切相关,与糖尿病肾脏病(DKD)的关系研究较少,本研究评估了2型糖尿病(T2DM)患者甲状腺功能水平与DKD的相关性。方法纳入2021年1-12月在河北以岭医院内分泌科住院患者553例,其中非DKD 304例,DKD 249例,收集临床人口学特征(年龄、糖尿病病程、收缩压、舒张压、糖尿病视网膜病变等),甲状腺功能(TSH,TT3,TT4,FT3,FT4,FT3/FT4),肾功能(BUN,SCr,UA,β2-MG,UACR),估计肾小球滤过率(eGFR)。综合分析评估患者人口学特征,甲状腺功能对DKD的影响。结果DKD占T2DM患者45.03%;DKD组糖尿病病程长,年龄大,血FT3,FT3/FT4在DKD组明显减低;FT3与eGFR呈正相关关系(r=0.219,P<0.01),与UACR,β2-MG,BUN呈负相关关系;FT3水平与DKD患病风险有关(OR:0.712,95%CI:0.564-0.901);进一步分层分析显示,FT3水平小于3.45 pmol/L时成为DKD发病的危险因素。而TSH,FT4各分层与DKD关联强度差异无统计学意义。结论甲状腺功能指标TSH,FT3与DKD密切相关,而FT3可作为DKD临床监测的敏感指标。

Objective Studies have shown that thyroid function is closely related to chronic kidney disease(CKD),and there are few studies on the relationship between thyroid function and diabetes kidney disease(DKD).This study aims to assess the relationship between thyroid function and DKD in patients with type 2 diabetes mellitus(T2DM).Methods Totally 553 inpatients in the Department of Endocrinology of Hebei Yiling Hospital from January 2021 to December 2021 were included,involving 304 non-DKD patients and 249 DKD patients.Clinical demographic characteristics(age,diabetes duration,systolic pressure,diastolic pressure,diabetes retinopathy,etc.),thyroid function(thyroid-stimulating hormone[TSH],total triiodothyronine[TT3],total thyroxine[TT4],free triiodothyronine[FT3],free thyroid hormone[FT4],FT3/FT4),renal function(blood urea nitrogen[BUN],serum creatinine[SCr],uric acid[UA],β2 microglobulin[β2-MG],urinary albumin-to-creatinine ratio[UACR]),estimated glomerular filtration rate(eGFR).Comprehensively analyze was performed to evaluate the effect of demographic characteristics and thyroid function of patients on DKD.Results There were proportion of 249/553(45.03%)DKD patients among the T2DM patients.In DKD group,patients with diabetes had a long diabetes duration and older.FT3 and FT3/FT4 were significantly reduced in DKD group,FT3 was positively correlated with eGFR(r=0.219,P<0.01)and negative correlation in UACR,β2-MG and BUN.FT3 levels were related to the risk of DKD(OR:0.712,95%CI:0.564-0.901).Further stratified analysis showed that FT3 level less than 3.45 pmol/L was a risk factor for DKD.However,the difference in correlation strength between TSH,FT4 and DKD was not statistically significant.Conclusion TSH and FT3 are closely related to DKD,and FT3 can be used as sensitive indicators for clinical monitoring of DKD.