甲状腺激素水平对2型糖尿病肾脏病风险的预测

doi:10.3969/j.issn.1004-583X.2023.02.007

摘要/Abstract

摘要：

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。

关键词: 糖尿病, 2型, 糖尿病肾病, 甲状腺功能, 游离三碘甲状腺原氨酸

Abstract:

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.

Key words: diabetes mellitus, type 2, diabetic nephropathies, thyroid function, free triiodothyronine

中图分类号:

R587.24

李会芳, 苗霞. 甲状腺激素水平对2型糖尿病肾脏病风险的预测[J]. 临床荟萃, 2023, 38(2): 137-142.

Li Huifang, Miao Xia. Prediction of thyroid hormone level on risk of type 2 diabetes nephropathy[J]. Clinical Focus, 2023, 38(2): 137-142.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.02.007

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I2/137

图/表 8

图1 本研究的逻辑流程图

Fig. 1 Flow chart of this study

表1 2组临床资料比较

Tab. 1 Comparison of clinical characteristics between non-DKD and DKD patients

项目	非DKD组( $n$ =304)	DKD组( $n$ =249)	$F$ /χ²/ $Z$	$P$ 值
年龄(岁)	60.34±10.37	62.95±9.78	0.638	0.003
病程(年)	10.27±7.068	12.57±7.807	-2.287	0.035
收缩压(mmHg)	141.75±18.821	144.79±20.843	-1.635	0.102
舒张压(mmHg)	80.10±11.497	80.84±12.162	-0.465	0.634
TSH(mU/L)	2.01(1.335, 3.195)	1.87(1.27, 3.09)	-0.993	0.351
TT3(nmol/L)	1.707±0.357	1.626±0.357	1.684	0.094
TT4(nmol/L)	104.33±20.393	103.247±19.768	-0.216	0.839
FT3(pmol/L)	4.315±0.801	4.156±0.781	0.528	0.019
FT4(pmol/L)	16.55(14.995, 18.693)	16.94(15.23, 18.895)	-1.423	0.155
eGFR[ml/(min·1.73 m²)]	97.766±16.396	86.818±22.813	25.032	0.001
FT3/FT4	0.261±0.05	0.248±0.054	0.299	0.003
BUN(mmol/L)	5.025±1.376	5.938±2.331	39.697	0.001
SCr(μmol/L)	66.005±12.287	74.861±27.111	59.506	0.001
UA(μmol/L)	303.254±83.572	313.935±91.835	5.463	0.153
β₂-MG(mg/L)	1.823±0.52	2.491±1.591	59.245	0.001
UACR(mg/g)	13.414±5.352	104.903±93.27	452.928	0.001
性别[例(%)]
男女	158(52.0) 146(48.0)	122(49.0) 127(51.0)	0.495	0.271

表1 2组临床资料比较

Tab. 1 Comparison of clinical characteristics between non-DKD and DKD patients

项目	非DKD组( $n$ =304)	DKD组( $n$ =249)	$F$ /χ²/ $Z$	$P$ 值
年龄(岁)	60.34±10.37	62.95±9.78	0.638	0.003
病程(年)	10.27±7.068	12.57±7.807	-2.287	0.035
收缩压(mmHg)	141.75±18.821	144.79±20.843	-1.635	0.102
舒张压(mmHg)	80.10±11.497	80.84±12.162	-0.465	0.634
TSH(mU/L)	2.01(1.335, 3.195)	1.87(1.27, 3.09)	-0.993	0.351
TT3(nmol/L)	1.707±0.357	1.626±0.357	1.684	0.094
TT4(nmol/L)	104.33±20.393	103.247±19.768	-0.216	0.839
FT3(pmol/L)	4.315±0.801	4.156±0.781	0.528	0.019
FT4(pmol/L)	16.55(14.995, 18.693)	16.94(15.23, 18.895)	-1.423	0.155
eGFR[ml/(min·1.73 m²)]	97.766±16.396	86.818±22.813	25.032	0.001
FT3/FT4	0.261±0.05	0.248±0.054	0.299	0.003
BUN(mmol/L)	5.025±1.376	5.938±2.331	39.697	0.001
SCr(μmol/L)	66.005±12.287	74.861±27.111	59.506	0.001
UA(μmol/L)	303.254±83.572	313.935±91.835	5.463	0.153
β₂-MG(mg/L)	1.823±0.52	2.491±1.591	59.245	0.001
UACR(mg/g)	13.414±5.352	104.903±93.27	452.928	0.001
性别[例(%)]
男女	158(52.0) 146(48.0)	122(49.0) 127(51.0)	0.495	0.271

表2 TSH与肾功能指标相关性分析

Tab. 2 Correlation analysis between TSH and renal function indexes

TSH	$r$ 值	$P$ 值
SCr	0.25	0.635
eGFR	-0.142	0.001
UA	0.032	0.533
UACR	-0.039	0.358
β₂-MG	-0.113	0.028
BUN	0.004	0.934

表2 TSH与肾功能指标相关性分析

Tab. 2 Correlation analysis between TSH and renal function indexes

TSH	$r$ 值	$P$ 值
SCr	0.25	0.635
eGFR	-0.142	0.001
UA	0.032	0.533
UACR	-0.039	0.358
β₂-MG	-0.113	0.028
BUN	0.004	0.934

表3 FT4与肾功能指标相关性分析

Tab. 3 Correlation analysis between FT4 and renal function indexes

FT4	$r$ 值	$P$ 值
SCr	0.041	0.333
eGFR	0.061	0.153
UA	-0.004	0.934
UACR	0.01	0.807
β₂-MG	0.037	0.387
BUN	0.052	0.221

表3 FT4与肾功能指标相关性分析

Tab. 3 Correlation analysis between FT4 and renal function indexes

FT4	$r$ 值	$P$ 值
SCr	0.041	0.333
eGFR	0.061	0.153
UA	-0.004	0.934
UACR	0.01	0.807
β₂-MG	0.037	0.387
BUN	0.052	0.221

表4 FT3与肾功能指标相关性分析

Tab. 4 Correlation analysis between FT3 and renal function indexes

FT3	$r$ 值	$P$ 值
SCr	-0.049	0.342
eGFR	0.219	0.001
UA	0.059	0.256
UACR	-0.19	0.001
β₂-MG	-0.19	0.001
BUN	-0.112	0.031

表4 FT3与肾功能指标相关性分析

Tab. 4 Correlation analysis between FT3 and renal function indexes

FT3	$r$ 值	$P$ 值
SCr	-0.049	0.342
eGFR	0.219	0.001
UA	0.059	0.256
UACR	-0.19	0.001
β₂-MG	-0.19	0.001
BUN	-0.112	0.031

表5 单因素、多因素Logistic回归分析DKD患病风险

Tab. 5 Univariate and multivariate Logistic analyses for DKD risk

	Crude- $O R$	$P$	95 $C I$	Adjusted $O R$	$P$
TSH	0.875	0.994	0.916~1.077
FT3	0.712	0.005	0.564~0.901	0.564~0.971	0.005
FT4	1.068	0.058	0.998~1.143	1.002~1.142	0.042
TT3	0.547	0.094	0.270~1.109
TT4	0.994	0.306	0.982~1.006
FT3/FT4	0.007	0.004	0.00~0.203

表5 单因素、多因素Logistic回归分析DKD患病风险

Tab. 5 Univariate and multivariate Logistic analyses for DKD risk

	Crude- $O R$	$P$	95 $C I$	Adjusted $O R$	$P$
TSH	0.875	0.994	0.916~1.077
FT3	0.712	0.005	0.564~0.901	0.564~0.971	0.005
FT4	1.068	0.058	0.998~1.143	1.002~1.142	0.042
TT3	0.547	0.094	0.270~1.109
TT4	0.994	0.306	0.982~1.006
FT3/FT4	0.007	0.004	0.00~0.203

表6 甲状腺功能TSH, FT3, FT4对DKD风险的分层分析

Tab. 6 TSH, FT3, FT4 stratified analyses for DKD risk

组别	频率	$O R$ (95% $C I$ )	$P$
TSH(mU/L)
<0.35	13	-	0.64
0.351~2.56	352	1.3969(0.448~4.35)	0.565
2.561~4.77	138	1.093(0.34~3.513)	0.882
>4.78	50	1.477(0.424~5.142)	0.54
FT3(pmol/L)
<3.44	70	-	0.036
3.45~4.24	195	0.435(0.249~0.76)	0.003
4.25~5.04	221	0.55(0.319~0.952)	0.03
>5.05	67	0.54(0.274~1.065)	0.076
FT4(pmol/L)
<14.5	83	-	0.552
14.16~16.94	217	1.031(0.617~1.724)	0.906
16.95~19.73	178	1.341(0.793~2.268)	0.274
>19.731	80	1.067(0.574~1.984)	0.838

表6 甲状腺功能TSH, FT3, FT4对DKD风险的分层分析

Tab. 6 TSH, FT3, FT4 stratified analyses for DKD risk

组别	频率	$O R$ (95% $C I$ )	$P$
TSH(mU/L)
<0.35	13	-	0.64
0.351~2.56	352	1.3969(0.448~4.35)	0.565
2.561~4.77	138	1.093(0.34~3.513)	0.882
>4.78	50	1.477(0.424~5.142)	0.54
FT3(pmol/L)
<3.44	70	-	0.036
3.45~4.24	195	0.435(0.249~0.76)	0.003
4.25~5.04	221	0.55(0.319~0.952)	0.03
>5.05	67	0.54(0.274~1.065)	0.076
FT4(pmol/L)
<14.5	83	-	0.552
14.16~16.94	217	1.031(0.617~1.724)	0.906
16.95~19.73	178	1.341(0.793~2.268)	0.274
>19.731	80	1.067(0.574~1.984)	0.838

图2 TSH, FT3, FT4对DKD风险的分层分析

Fig. 2 Stratified analyses chart of TSH, FT3 and FT4 for DKD risk

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