Shimizu Yuji, Kawashiri Shin-Ya, Noguchi Yuko, Nakamichi Seiko, Nagata Yasuhiro, Maeda Takahiro, Hayashida Naomi
Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan.
Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Diseases Prevention, Osaka 537-8511, Japan.
Diagnostics (Basel). 2022 Feb 11;12(2):462. doi: 10.3390/diagnostics12020462.
Subclinical hypothyroidism (SCH) was reported to be associated with accelerating endothelial dysfunction, which is recognized as one of the upstream mechanisms that leads to glomerular injury (lower glomerular filtration rate (GFR)). SCH was also reported to be associated with hyperglycemia, which is associated with higher hemoglobin A1c (HbA1c) levels and induces endothelial dysfunction. Therefore, SCH status could influence the association between HbA1c and reduced eGFR. To clarify those associations, we conducted a prospective study of 1580 Japanese individuals who participated in an annual health check-up in 2014 with 2.8 years of follow-up. All participants had free triiodothyronine (T3) and free thyroxine (T4) levels in the normal range. Among study participants, 88 were diagnosed as having SCH. Even though no significant correlation was observed between HbA1c and annual change in estimated GFR among participants without SCH (multi-adjusted standardized parameter estimate (β) = 0.03, = 0.250), a significant inverse association was observed among participants with SCH (β = -0.26, = 0.014). When those analyses were performed among participants who were not taking glucose lowering medication, the observed associations were essentially the same: β = 0.03, = 0.266 for participants without SCH and β = -0.32, = 0.006 for participants with SCH, respectively. Therefore, SCH status could influence the association between HbA1c and renal function.
据报道，亚临床甲状腺功能减退（SCH）与内皮功能障碍加速有关，而内皮功能障碍被认为是导致肾小球损伤（肾小球滤过率（GFR）降低）的上游机制之一。另据报道，SCH还与高血糖有关，高血糖与较高的糖化血红蛋白（HbA1c）水平相关，并会导致内皮功能障碍。因此，SCH状态可能会影响HbA1c与估算肾小球滤过率（eGFR）降低之间的关联。为了阐明这些关联，我们对1580名参加2014年年度健康检查的日本人进行了一项前瞻性研究，并进行了2.8年的随访。所有参与者的游离三碘甲状腺原氨酸（T3）和游离甲状腺素（T4）水平均在正常范围内。在研究参与者中，88人被诊断为患有SCH。尽管在没有SCH的参与者中，未观察到HbA1c与估算GFR的年度变化之间存在显著相关性（多元调整标准化参数估计值（β）= 0.03，P = 0.250），但在患有SCH的参与者中观察到显著的负相关（β = -0.26，P = 0.014）。当在未服用降糖药物的参与者中进行这些分析时，观察到的关联基本相同：没有SCH的参与者β = 0.03，P = 0.266，患有SCH的参与者β = -0.32，P = 0.006。因此，SCH状态可能会影响HbA1c与肾功能之间的关联。
