成年健康体检人群甲状腺功能与慢性肾脏病的相关性研究

The correlation between thyroid function and chronic kidney disease in adults receiving physical examination

目的探讨成年健康体检人群甲状腺功能与慢性肾脏病(CKD)的相关性。方法本研究为横断面研究,选取2021年1至12月在山东第一医科大学第一附属医院健康体检的成年人群为研究对象,通过体检收集临床资料,包括年龄、性别、身高、体重、血压等,测定血糖、血脂、血肌酐、血尿酸、尿常规、甲状腺功能[游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]等指标。应用多因素logistic回归模型探讨甲状腺功能指标与CKD的相关性,受试者工作特征(ROC)曲线探讨甲状腺功能指标评价CKD的能力。结果本研究共纳入研究对象46342例,年龄为(47.6±14.3)岁,男性占比56.2%。估算的肾小球滤过率[eGFR<60 ml·min-1·(1.73 m2)-1]、蛋白尿及CKD的检出率分别为1.15%、0.53%和1.58%。TSH亚组分析显示,甲减组中DeGFR、蛋白尿及CKD的检出率明显升高,达1.07%、2.36%和3.20%(均P<0.05)。校正了混杂因素后,FT3与CKD(OR=0.63,95%CI:0.54~0.74)呈负相关;FT4(OR=1.05,95%CI:1.03~1.07)及TSH(OR=1.03,95%CI:1.01~1.04)与CKD呈正相关。在排除检出糖尿病、高血压的人群中也得到类似结果(P<0.05)。FT3评价CKD的能力优于FT4及TSH,其曲线下面积为0.63,截断值为4.18 pmol/L,灵敏度及特异度分别为57.5%和62.6%。结论成年健康体检人群中甲状腺功能状态与CKD的发病密切相关,FT3是CKD发病的危险因素。

Objective To explore the association between thyroid function and chronic kidney disease(CKD)in adults.Methods A cross-sectional study was conducted in adults who received health checkup in the First Affiliated Hospital of Shandong First Medical University from January to December in 2021.Clinical data were collected,including age,gender,height,weight,blood pressure,etc.And blood glucose,blood lipid,blood creatinine,blood uric acid,routine urine function,thyroid function(free triiodine,free thyroxine,thyroid stimulating hormone)were measured.Multivariate logistic regression model was used to investigate the correlation between thyroid function indicators and the onset of CKD;and receiver operator characteristic(ROC)curve was used to explore the ability of thyroid function indicators in evaluating CKD.Results In the study,46342 adults with an average age of(47.6±14.3)years were enrolled,of which 56.2%were males.The prevalence of DeGFR(eGFR<60 ml·min-1·(1.73 m2)-1),proteinuria and CKD was 1.15%,0.53%and 1.58%,respectively.The TSH subgroup analysis showed that the prevalence of DeGFR,albuminuria and CKD in the hypothyroidism group was significantly increased to 1.07%,2.36%and 3.20%,respectively(all P<0.05).After adjusting for confounding factors,multivariate logistic regression analysis showed that FT3 was negatively associated with CKD(OR=0.63,95%CI:0.54-0.74),however FT4(OR=1.05,95%CI:1.03-1.07)and TSH(OR=1.03,95%CI:1.01-1.04)were positively correlated with CKD.Similar results were obtained in the subgroup without hypertension and diabetes(P<0.05).The ROC analysis indicated that FT3 had a better capability for evaluating CKD than FT4 and TSH,with an area under the curve of 0.63,a cut-off value of 4.18 pmol/L,and a sensitivity and specificity of 57.5%and 62.6%,respectively.Conclusions Thyroid function status is closely associated with the onset of CKD in the adult population receiving health check-up.FT3 is a risk factor for the onset of CKD.