Department of Cardiology, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Endocr Pract. 2013 May-Jun;19(3):397-403. doi: 10.4158/EP12282.OR.
To determine the relationship between thyroid-stimulating hormone (TSH) and cystatin C (CysC) and estimated glomerular filtration rate calculated by Cys C (eGFR(CysC)).
We conducted a cross-sectional study including 8,126 male participants. Serum creatinine (Cr), CysC, eGFR calculated by Cr (eGFR(Cr)), and eGFR(CysC) were determined and compared in euthyroid and subclinical thyroid dysfunction patients. Relationships between TSH and Cr, cystatin C, eGFR(Cr), and eGFR(CysC) were assessed by linear and quadratic trend analyses. Odds ratios (ORs) of chronic kidney disease (CKD; eGFR<60 mL/min/1.73 m2) were calculated according to categories of thyroid function using TSH values of 2.01-3.00 mIU/L as a reference.
Serum CysC level was significantly elevated, and eGFR(CysC) was significantly reduced in both subclinical hypothyroidism and subclinical hyperthyroidism. TSH was negatively and linearly associated with Cr and eGFR(Cr) (P<.001). Quadratic trends were found between TSH and cystatin C or eGFR(CysC) (P<.001). Compared with individuals with TSH of 2.01-3.00 mIU/L, the prevalence of CKD(CysC) was significantly higher in subjects with TSH<0.40 mIU/L, 3.01-4.00 mIU/L, and 4.01-7.00 mIU/L, while the prevalence of CKD(Cr) was only significantly higher in subjects with TSH>7.0 mIU/L.
Despite only studying male subjects and using eGFR rather than standard GFR, we conclude that thyroid function differentially affects serum CysC and Cr concentrations. Subclinical hypothyroidism and subclinical hyperthyroidism are both associated with elevated CysC, reduced eGFR(CysC), and higher prevalence of CKDCysC. Assessment of renal function with CysC should be avoided in patients with thyroid dysfunction.
确定促甲状腺激素（TSH）与胱抑素 C（CysC）以及由 CysC 计算的肾小球滤过率（eGFR(CysC)）之间的关系。
我们进行了一项横断面研究，纳入了 8126 名男性参与者。测定并比较了甲状腺功能正常和亚临床甲状腺功能减退或亢进患者的血清肌酐（Cr）、CysC、由 Cr 计算的 eGFR（eGFR(Cr)）以及由 CysC 计算的 eGFR（eGFR(CysC)）。通过线性和二次趋势分析评估 TSH 与 Cr、胱抑素 C、eGFR(Cr)和 eGFR(CysC)之间的关系。根据甲状腺功能的类别，使用 TSH 值为 2.01-3.00 mIU/L 作为参考，计算慢性肾脏病（eGFR<60 mL/min/1.73 m2）的优势比（OR）。
亚临床甲状腺功能减退和亚临床甲状腺功能亢进患者的血清 CysC 水平显著升高，eGFR(CysC)显著降低。TSH 与 Cr 和 eGFR(Cr)呈负相关和线性关系（P<.001）。TSH 与胱抑素 C 或 eGFR(CysC)之间存在二次趋势（P<.001）。与 TSH 为 2.01-3.00 mIU/L 的个体相比，TSH<0.40 mIU/L、3.01-4.00 mIU/L 和 4.01-7.00 mIU/L 的个体的 CKD(CysC)患病率显著更高，而 TSH>7.0 mIU/L 的个体的 CKD(Cr)患病率仅显著更高。
尽管仅研究了男性受试者并使用了 eGFR 而不是标准 GFR，但我们得出结论，甲状腺功能会对血清 CysC 和 Cr 浓度产生不同的影响。亚临床甲状腺功能减退和亚临床甲状腺功能亢进均与 CysC 升高、eGFR(CysC)降低和 CKD(CysC)患病率升高有关。在甲状腺功能障碍患者中，应避免使用 CysC 评估肾功能。
