低T3综合征与2型糖尿病患者糖尿病肾病发生的关系

Association between low T3 syndrome and the risk of diabetic kidney disease in patients with type 2 diabetes mellitus

目的探讨低T3综合征(LT3S)的发生与糖尿病肾病(DKD)患者病情进展的关系。方法选取2020年1月至2022年2月在该院肾内科和内分泌科住院的202例T2DM患者为研究对象,并根据是否存在DKD,将患者分为NDKD组和DKD组。比较两组患者临床资料、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)、清蛋白(ALB)、尿素氮(BUN)、糖化血红蛋白(HbA1c)、血清三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)和促甲状腺激素(TSH)等水平,根据慢性肾脏病流行病协作研究(CKD-EPI)公式由肌酐(Scr)计算肾小球滤过率(eGFR),结合反T3(rT3)数据明确LT3S的诊断,分析DKD发生的危险因素。结果NDKD组89例,DKD组113例。202例T2DM患者合并LT3S 14例,LT3S发病率为6.93%,LT3S在DKD组中的发生率为12.39%。DKD组年龄明显大于NDKD组,T2DM病程明显长于NDKD组,差异均有统计学意义(P<0.05)。与NDKD组比较,DKD组ACR、BUN水平明显升高,而ALB和eGFR水平明显降低,差异均有统计学意义(P<0.05)。与NDKD组比较,DKD组的T3和FT3水平明显降低,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,BUN水平升高是DKD发生的危险因素(P<0.05),FT3水平升高是DKD发生的保护因素(P<0.05)。结论T2DM患者T3、FT3水平下降与DKD发生有关,即随着T2DM患者并发DKD,LT3S的发生率增加。早期检测甲状腺激素水平,有助于DKD患者的早期诊断和病情评估。

Objective To investigate the association between the occurrence of low T3 syndrome(LT3S)and the disease progression in patients with diabetic kidney disease(DKD).Methods A total of 202 patients with type 2 diabetes mellitus(T2DM)were selected as objects and divided into NDKD group(89 cases)and DKD group(113 cases)according to whether complicated with DKD or not.General clinical indicators and plasma alanine aminotransferase(ALT),aspartate aminotransferase(AST),total cholesterol(TC),triglyceride(TG),albumin(ALB),urea(BUN),glycosylated hemoglobin(HbA1c),serum triiodothyronine(T3),free triiodothyronine(FT3),Thyroxine(T4),free thyroxine(FT4)and thyroid-stimulating hormone(TSH)levels were collected and compared.The glomerular filtration rate(eGFR)was calculated by creatinine(Scr)according to the CKD-EPI formula.Combined with the inverse T3(rT3)data,the diagnosis of LT3S was confirmed,and the risk factors of DKD were analyzed.Results There were 89 cases in NDKD group,113 cases in DKD group.There were 14 cases in 202 T2DM patients complicated with LT3S,with an incidence of 6.93%,and the incidence of LT3S in the DKD group was 12.39%.Compared with NDKD group,the age was greater,the course of T2DM was longer in DKD group,with statistical significance(P<0.05).Compared with NDKD group,the levels of ACR and BUN in DKD group increased,while the levels of ALB and eGFR decreased,with statistical significance(P<0.05).Compared with NDKD group,T3 and FT3 levels in DKD group decreased,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that the increase of BUN level was the risk factors for DKD(P<0.05).Increased FT3 level was a protective factor for DKD(P<0.05).Conclusion The decreased levels of T3 and FT3 in T2DM patients correlate with the severity of DKD.With the progression of microvascular complications DKD in T2DM patients,the incidence of LT3S increases.Early detection of thyroid hormone level is helpful for early diagnosis and disease evaluation of DKD patients.