Zhou Jian-Bo, Li Hong-Bing, Zhu Xiao-Rong, Song Hai-Lin, Zhao Ying-Ying, Yang Jin-Kui
Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing Department of General Surgery, Weihaiwei People's Hospital, Weihai Critical Care Medicine, Beijing Jiangong Hospital Beijng Key Laboratory of Diabetes Research and Care, Beijing, China.
Medicine (Baltimore). 2017 Apr;96(15):e6519. doi: 10.1097/MD.0000000000006519.
Evidence indicated a positive association between subclinical hypothyroidism (SCH) and cardiovascular diseases. But the relationship between SCH and chronic kidney diseases (CKD) remains unclear. A case-control study was performed to ascertain this relationship followed by a meta-analysis. In this hospital-based, case-control study, we recruited 3270 type 2 diabetic patients with euthyroidism and 545 type 2 diabetic patients with SCH. All English studies were searched upon the relationship between SCH and CKD up to October 2016. Meta-analysis was performed using STATA 13.0 software. Our case-control study indicated an association between SCH and CKD in patients with type 2 diabetes [OR (95% CI): 1.22 (1.09-1.36)]. Five observational studies reporting risk of CKD in SCH individuals were enrolled. A significant relationship between SCH and CKD was shown [pooled OR 1.80, (95% CI) 1.38-2.35]. Among normal TSH range, individuals with TSH ≥3.0 μIU/ml had a significantly higher rate of CKD (Fisher exact test, P = 0.027). Dose-response linear increase of CKD events was explored [pooled OR 1.09 (95% CI): 1.03-1.16 per1 mIU/L increase of TSH]. The present evidence suggests that SCH is probably a significant risk factor of CKD in T2D. Linear trend is shown between TSH elevation and CKD in T2D. This relationship between serum TSH and renal impairment in type 2 diabetic patients needs further studies to investigate.
有证据表明亚临床甲状腺功能减退（SCH）与心血管疾病之间存在正相关。但SCH与慢性肾脏病（CKD）之间的关系仍不明确。进行了一项病例对照研究以确定这种关系，随后进行了荟萃分析。在这项基于医院的病例对照研究中，我们招募了3270例甲状腺功能正常的2型糖尿病患者和545例SCH的2型糖尿病患者。检索了截至2016年10月所有关于SCH与CKD关系的英文研究。使用STATA 13.0软件进行荟萃分析。我们的病例对照研究表明2型糖尿病患者中SCH与CKD之间存在关联[比值比（95%置信区间）：1.22（1.09 - 1.36）]。纳入了五项报告SCH个体患CKD风险的观察性研究。结果显示SCH与CKD之间存在显著关系[合并比值比1.80，（95%置信区间）1.38 - 2.35]。在促甲状腺激素（TSH）正常范围内，TSH≥3.0μIU/ml的个体患CKD的比例显著更高（Fisher精确检验，P = 0.027）。探讨了CKD事件的剂量反应线性增加情况[合并比值比1.09（95%置信区间）：TSH每升高1 mIU/L为1.03 - 1.16]。目前的证据表明，SCH可能是2型糖尿病中CKD的一个重要危险因素。2型糖尿病中TSH升高与CKD之间呈线性趋势。2型糖尿病患者血清TSH与肾功能损害之间的这种关系需要进一步研究来探究。
