Han Qianqian, Zhang Junlin, Wang Yiting, Li Hanyu, Zhang Rui, Guo Ruikun, Li Li, Teng Geer, Wang Jiali, Wang Tingli, Liu Fang
Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.
The Faculty of Social Development and Western China Development Studies, Sichuan University, Chengdu, China.
Nephrology (Carlton). 2019 Feb;24(2):160-169. doi: 10.1111/nep.13388.
Although abnormal thyroid hormone metabolism is common in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN), the relationship between thyroid hormones and DN is unclear and has been ignored during clinical practice. This study aimed to investigate the relationship between thyroid hormones and clinicopathologic changes in biopsy-proven DN patients.
Clinical and pathological data for 146 biopsy-proven DN patients were collected. The patients were divided into four groups: euthyroid group, high-thyroid stimulating hormone (TSH) group (SCH), low-free triiodothyronine (FT3) group (with normal levels of TSH and FT4), and high-TSH + low-FT3 group (with normal levels of FT4). The clinicopathologic features among the four groups were investigated. We evaluated the risks of abnormal thyroid hormone levels on DN by logistic regression with multivariable adjustments for other risk factors. We also performed quarterback and eight-point analyses of TSH and FT3 levels to determine their influences on DN.
The overt proteinuria (>5 g/24 h) (P = 0.008) and severity of glomerular lesions (P = 0.011) differed between euthyroid group and high-TSH group significantly. Moreover, the levels of estimated glomerular filtration rate (P =0.019), serum creatinine (P =0.014), and severity of glomerular lesions (P =0.003) differed between the euthyroid group and low-FT3 group significantly. There were also significant differences between high-TSH, low-FT3 and high-TSH + low-FT3 patients, respectively. Respective correlations between high-TSH, low-FT3 and renal clinicopathologic changes were found to be significant according to logistic regression analyses. Quarterback and eight-point analyses indicated that patients with TSH levels of 4.54-5.67 mU/L had the most severe renal clinicopathologic changes, and the severity of renal changes decreased with increased FT3 levels.
Diabetic nephropathy patients with high-TSH and/or low-FT3 had more severe proteinuria, renal insufficiency, and glomerular lesions, suggesting that regulating thyroid hormones might have a renoprotective effect.
虽然甲状腺激素代谢异常在2型糖尿病（T2DM）和糖尿病肾病（DN）患者中很常见，但甲状腺激素与DN之间的关系尚不清楚，且在临床实践中一直被忽视。本研究旨在探讨经活检证实的DN患者甲状腺激素与临床病理变化之间的关系。
收集146例经活检证实的DN患者的临床和病理资料。将患者分为四组：甲状腺功能正常组、高促甲状腺激素（TSH）组（SCH）、低游离三碘甲状腺原氨酸（FT3）组（TSH和FT4水平正常）和高TSH+低FT3组（FT4水平正常）。研究四组患者的临床病理特征。我们通过对其他危险因素进行多变量调整的逻辑回归分析，评估甲状腺激素水平异常对DN的风险。我们还对TSH和FT3水平进行了四分位和八分位分析，以确定它们对DN的影响。
甲状腺功能正常组与高TSH组之间，显性蛋白尿（>5 g/24 h）（P = 0.008）和肾小球病变严重程度（P = 0.011）存在显著差异。此外，甲状腺功能正常组与低FT3组之间，估算肾小球滤过率水平（P = 0.019）、血清肌酐（P = 0.014）和肾小球病变严重程度（P = 0.003）存在显著差异。高TSH组、低FT3组和高TSH+低FT3组患者之间也存在显著差异。根据逻辑回归分析，发现高TSH、低FT3与肾脏临床病理变化之间分别存在显著相关性。四分位和八分位分析表明，TSH水平为4.54 - 5.67 mU/L的患者肾脏临床病理变化最严重，且肾脏变化的严重程度随FT3水平升高而降低。
高TSH和/或低FT３的糖尿病肾病患者蛋白尿、肾功能不全和肾小球病变更严重，提示调节甲状腺激素可能具有肾脏保护作用。
