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

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

Abstract

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

CLC Number:

R587.24

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.02.007

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

Figures/Tables 8

Fig. 1 Flow chart of this study

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

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

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

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

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

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

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

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

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

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

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

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

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

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