糖尿病肾脏疾病与甲状腺功能状态的相关性

Study on the relationship between diabetes kidney diseas and thyroid functionn

目的探讨甲状腺激素水平与糖尿病肾脏疾病(diabetes kidney disease,DKD)的相关性。方法回顾性分析2019年3月至9月于青岛市城阳区人民医院内分泌科就诊的750例糖尿病(diabetes mellitus,DM)患者,其中250例DM伴正常蛋白尿(DM组),250例DM伴微量蛋白尿(微量蛋白尿组),250例DM伴临床蛋白尿(临床蛋白尿组),对照组为健康体检者250例。收集研究对象的收缩压、舒张压、身高、体质量等指标;收集研究对象空腹8~10 h检测的血糖、血脂、血肌酐(serum creatinine,Scr)、促甲状腺激素(thyroid stimulating hormone,TSH)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4);收集随机尿检测尿肌酐(urinary creatinine,Ucr)、尿微量白蛋白(urinary albumin,Ualb),并根据检测结果计算Ualb/Ucr(urinary albumin to creatinine,UACR)和估计肾小球滤过率(estimated glomerular filtration rate,eGFR),分析各组差异和相关性。结果4组间TSH水平比较,差异有统计学意义(P<0.001),呈现的趋势为临床蛋白尿组>微量蛋白尿组>DM组>对照组;4组间FT3水平、FT4水平比较,差异有统计学意义(P<0.001),呈现的趋势为临床蛋白尿组<微量蛋白尿组<DM组<对照组。秩相关分析结果显示,微量蛋白尿组的TSH水平与Scr、UACR呈正相关,与eGFR呈负相关,差异均有统计学意义(P<0.001);微量蛋白尿组FT3水平与Scr、UACR和eGFR水平呈正相关,差异均有统计学意义(P<0.001);临床蛋白尿组的TSH水平与Scr、UACR呈正相关,与eGFR呈负相关,差异均有统计学意义(P<0.001);临床白蛋白尿组FT4、FT3水平与Scr、UACR和eGFR呈正相关,差异均有统计学意义(P<0.001)。结论DKD伴随TSH水平升高和FT3、FT4水平降低,且随着肾损害加重上述激素水平更加异常。

Objective:To study the relationship between thyroid hormone level and diabetes kidney disease(DKD).Methods:This study retrospectively analyzed the patients with diabetes(DM)and the healthy people who received medical examination in the Department of Endocrinology,Chengyang District People's Hospital,Qingdao from March to September 2019,including 250 cases of DM with normal proteinuria(DM group),250 cases of DM with microalbuminuria(microalbuminuria group),and 250 cases of DM with clinical albuminuria(clinical albuminuria group).The control group was 250 healthy people who received medical examination.The anthropometric indexes such as systolic blood pressure,diastolic blood pressure,height and weight were collected.Collect the blood glucose,blood lipids,serum creatinine(Scr),thyroid stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)of the subjects who were tested after 8-10 hours of fasting,collect and take the morning random urine to test the urine creatinine and urine microalbumin,and calculate the urine albumin/creatinine(UACR)and estimated glomerular filtration rate(eGFR),and compare the differences and correlations between the groups.Results:There was a statistically significant difference in TSH levels among the four groups(P<0.001),with the trend of clinical albuminuria group>microalbuminuria group>DM group>control group;There was a statistically significant difference in the levels of FT3 and FT4 among the four groups(P<0.001).The trend was that the clinical albuminuria group<microalbuminuria group<DM group<control group.The results of rank correlation analysis showed that the positive correlation of TSH level with Scr and UACR in microalbuminuria group showed statistical difference(P<0.001),and the negative correlation with eGFR showed statistical difference(P<0.001);The positive correlation between FT3 level and the levels of Scr,UACR and eGFR in microalbuminuria group showed statistical difference(P<0.001);The positive correlation between TSH level and Scr and UACR in clinical albuminuria group showed statistical difference(P<0.001),and the negative correlation with eGFR showed statistical difference(P<0.001);The positive correlation between the levels of FT4,FT3 and the levels of Scr,UACR and eGFR in clinical albuminuria group showed statistical differences(P<0.001).Conclusion:DKD is accompanied by the increase of TSH level and the decrease of FT3 and FT4 levels,and the abnormality of these hormone levels is more significant with the aggravation of renal damage.