Lee Da Young, Jee Jae Hwan, Jun Ji Eun, Kim Tae Hyuk, Jin Sang-Man, Hur Kyu Yeon, Kim Sun Wook, Chung Jae Hoon, Lee Moon-Kyu, Kim Jae Hyeon
Department of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Endocrinology and Metabolism, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Endocrine. 2017 Feb;55(2):503-512. doi: 10.1007/s12020-016-1138-8. Epub 2016 Oct 5.
The objective of this study is to evaluate the predictive values of baseline thyroid-stimulating hormone and the rate of thyroid-stimulating hormone change within the euthyroid state on the development of chronic kidney disease. We conducted a longitudinal study in 17,067 Korean adults with normal thyroid function and no history of thyroid disease. Incident chronic kidney disease was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m. The rate of thyroid-stimulating hormone change was determined by subtracting the baseline thyroid-stimulating hormone level from the thyroid-stimulating hormone level measured at the last visit prior to the diagnosis of chronic kidney disease or at the final visit in subjects without chronic kidney disease, divided by the observation period (years). Subjects were stratified into quintiles according to rates of thyroid-stimulating hormone change. During 86,583 person-years of follow-up (median follow-up 5.2 years), there were 561 incident cases of chronic kidney disease. The risk of incident chronic kidney disease was significantly higher in subjects with rapid increases (quintile 5) or decreases (quintile 1) in thyroid-stimulating hormone levels compared to the reference group (quintile 3). In fully adjusted models, the hazard ratios of quintiles 1 and 5 were 3.15 (95 % confidence interval 2.34 to 4.24; p < 0.001) and 3.37 (95 % confidence interval 2.52 to 4.51; p < 0.001), respectively. However, there was no significant association between baseline thyroid-stimulating hormone and risk of incident chronic kidney disease. The development of chronic kidney disease is associated with the rate of changes in thyroid-stimulating hormone level rather than with baseline thyroid-stimulating hormone levels.
本研究的目的是评估促甲状腺激素基线水平以及甲状腺功能正常状态下促甲状腺激素变化率对慢性肾脏病发生发展的预测价值。我们对17067名甲状腺功能正常且无甲状腺疾病史的韩国成年人进行了一项纵向研究。新发慢性肾脏病定义为估算肾小球滤过率<60 ml/min/1.73 m²。促甲状腺激素变化率的计算方法是，用诊断慢性肾脏病前最后一次就诊时或无慢性肾脏病受试者最后一次就诊时测得的促甲状腺激素水平减去基线促甲状腺激素水平，再除以观察期（年）。根据促甲状腺激素变化率将受试者分为五个五分位数组。在86583人年的随访期内（中位随访时间5.2年），有561例新发慢性肾脏病病例。与参照组（五分位数3）相比，促甲状腺激素水平快速升高（五分位数5）或快速降低（五分位数1）的受试者发生新发慢性肾脏病的风险显著更高。在完全调整模型中，五分位数1和五分位数5的风险比分别为3.15（95%置信区间2.34至4.24；p<0.001）和3.37（95%置信区间2.52至4.51；p<0.001）。然而，促甲状腺激素基线水平与新发慢性肾脏病风险之间无显著关联。慢性肾脏病的发生发展与促甲状腺激素水平的变化率有关，而非与促甲状腺激素基线水平有关。
