Yang Zhi, Duan Peng, Li Weihong, Nie Ronghui, Lou Xiaoyang, Wang Lina, Wu Kexia, Liu Jiang, Tu Ping, Lai Xiaoyang
Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, People's Republic of China.
Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China.
Diabetes Metab Syndr Obes. 2022 Jan 5;15:59-67. doi: 10.2147/DMSO.S347862. eCollection 2022.
We investigated the relationship between thyroid hormones and the risk of diabetic kidney disease (DKD) progression.
A total of 452 patients with type 2 diabetes were included, and a cross-sectional analysis was performed. Urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were used to diagnose persistent albuminuria and stage chronic kidney disease, respectively. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline was used to describe the risk of DKD progression (low, moderate, and high or very high risks).
The DKD group had higher levels of thyroid-stimulating hormone (TSH) and lower levels of free triiodothyronine (FT) and free thyroxine (FT) than the non-DKD group. The prevalence of thyroid dysfunction in the DKD group was significantly higher than in the non-DKD group, especially the prevalence of subclinical hypothyroidism. FT levels decreased gradually with the deterioration of DKD. TSH levels increased with an increasing KDIGO category. FT and FT levels were negatively correlated with serum creatinine levels and ACR, and positively correlated with eGFR. Contrastingly, TSH was positively correlated with ACR, and negatively correlated with eGFR. After adjustment, an increase in FT levels significantly reduced the risk of DKD [odds ratio, OR (95% confidence interval, CI)=0.58 (0.42-0.79)] and DKD progression [ORs (95% CIs)=0.65 (0.45-0.93) for the moderate risk group and 0.50 (0.33-0.74) for the high or very high-risk group, using the low-risk group as a reference]. FT levels below 4.30 pmol/L in men and 3.99 pmol/L in women were the cut-off points for an increased risk of DKD progression.
Low FT level is an independent risk factor for DKD and DKD progression. FT ≤4.30 pmol/L in men and ≤3.99 pmol/L in women will greatly increase the risk of kidney disease progression in patients with type 2 diabetes.
我们研究了甲状腺激素与糖尿病肾病（DKD）进展风险之间的关系。
共纳入452例2型糖尿病患者，并进行横断面分析。尿白蛋白/肌酐比值（ACR）和估计肾小球滤过率（eGFR）分别用于诊断持续性蛋白尿和分期慢性肾脏病。采用肾脏病改善全球预后（KDIGO）临床实践指南描述DKD进展风险（低、中、高或非常高风险）。
与非DKD组相比，DKD组促甲状腺激素（TSH）水平较高，游离三碘甲状腺原氨酸（FT）和游离甲状腺素（FT）水平较低。DKD组甲状腺功能障碍的患病率显著高于非DKD组，尤其是亚临床甲状腺功能减退的患病率。随着DKD的恶化，FT水平逐渐降低。TSH水平随着KDIGO分类的增加而升高。FT和FT水平与血清肌酐水平和ACR呈负相关，与eGFR呈正相关。相反，TSH与ACR呈正相关，与eGFR呈负相关。调整后，FT水平升高显著降低了DKD风险[比值比，OR（95%置信区间，CI）=0.58（0.42 - 0.79）]和DKD进展风险[以低风险组为参照，中风险组的OR（95%CI）=0.65（0.45 - 0.93），高或非常高风险组的OR（95%CI）=0.50（0.33 - 0.74）]。男性FT水平低于4.30 pmol/L和女性低于3.99 pmol/L是DKD进展风险增加的切点。
低FT水平是DKD及其进展的独立危险因素。男性FT≤4.30 pmol/L且女性≤3.99 pmol/L会大大增加2型糖尿病患者肾病进展的风险。
