2型糖尿病（T2DM）中甲状腺功能障碍（TD）与糖尿病肾病（DKD）之间的关联。

The association between thyroid dysfunction (TD) and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM).

作者信息

Zheng Mao, Wang Dong, Chen Li, Chen Mei-Nan, Wang Wei, Ye Shan-Dong

机构信息

Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, P. R. China.

Department of Endocrinology, The Third Affiliated Hospital of AHMU (The First People's Hospital of Hefei City), Hefei, P. R. China.

出版信息

Int J Clin Pract. 2019 Sep 11:e13415. doi: 10.1111/ijcp.13415.

DOI:10.1111/ijcp.13415

PMID:31508877

Abstract

BACKGROUND

Epidemiological studies have identified an association between thyroid dysfunction (TD) and various kidney diseases. In this study, the prevalence of TD in type 2 diabetic mellitus (T2DM) patients with diabetic kidney disease (DKD) was evaluated to analyse the potential association between TD and DKD in T2DM patients.

METHODOLOGY

A total of 2108 T2DM patients from Anhui Provincial Hospital were recruited in this study. Demographic and clinical characteristics were collected from 834 T2DM patients with DKD and 1274 T2DM patients without DKD (non-DKD). All patients were stratified into a number of groups based on UACR (urine albumin-to-creatinine ratio) or eGFR (estimated glomerular filtration rate): (a) A1: normoalbuminuria (<30), A2: microalbuminuria (30-300) and A3: macroalbuminuria (>300); (b) F1: normal filtration (60-139), F2: hyper filtration (≥140) and F3: low filtration (<60).

RESULTS

Significant differences were observed between the non-DKD and DKD groups (P < .05) in age, sex ratio, duration, systolic blood pressure, total cholesterol, low density lipoprotein cholesterol, serum creatinine, blood urea nitrogen, free triiodothyronine (FT3), free thyroxine (FT4) and sensitive thyrotropin hormone (sTSH). The macroalbuminuira and low filtration groups had the lowest levels of FT3 and FT4 and the highest level of sTSH, compared with all other groups (P < .0167). The prevalence of subclinical hypothyroidism in the DKD group was significantly higher than that in the non-DKD group (χ = 13.92, P < .01). Logistic regression analysis showed that hypothyroidism was associated with increased UACR or reduced eGFR in T2DM patients. Compared with controls, T2DM patients with hypothyroidism exhibited a higher UACR and urinary excretion of transferrin, as well as a lower excretion of urinary Tamm-Horsfall protein (THP) (P < .0167).

CONCLUSION

Subclinical hypothyroidism is more prevalent in T2DM patients with DKD than in T2DM patients without DKD. Hypothyroidism is associated with albuminuria and decreased eGFR in T2DM patients.

摘要

背景

流行病学研究已确定甲状腺功能障碍（TD）与各种肾脏疾病之间存在关联。在本研究中，评估了2型糖尿病（T2DM）合并糖尿病肾病（DKD）患者中TD的患病率，以分析TD与T2DM患者DKD之间的潜在关联。

方法

本研究招募了安徽省立医院的2108例T2DM患者。收集了834例合并DKD的T2DM患者和1274例未合并DKD（非DKD）的T2DM患者的人口统计学和临床特征。所有患者根据尿白蛋白与肌酐比值（UACR）或估算肾小球滤过率（eGFR）分为若干组：（a）A1：正常白蛋白尿（<30），A2：微量白蛋白尿（30 - 300），A3：大量白蛋白尿（>300）；（b）F1：正常滤过（60 - 139），F2：高滤过（≥140），F3：低滤过（<60））。

结果

非DKD组和DKD组在年龄、性别比、病程、收缩压、总胆固醇、低密度脂蛋白胆固醇、血清肌酐、血尿素氮、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（sTSH）方面存在显著差异（P <.05）。与所有其他组相比，大量白蛋白尿组和低滤过组的FT3和FT4水平最低，sTSH水平最高（P <.0167）。DKD组亚临床甲状腺功能减退的患病率显著高于非DKD组（χ² = 13.92，P <.01）。逻辑回归分析表明，甲状腺功能减退与T2DM患者UACR升高或eGFR降低有关。与对照组相比，甲状腺功能减退的T2DM患者表现出更高的UACR和转铁蛋白尿排泄，以及更低的尿Tamm - Horsfall蛋白（THP）排泄（P <.0167）。