格雷夫斯病与终末期肾脏疾病风险：一项韩国基于人群的研究。
Graves' Disease and the Risk of End-Stage Renal Disease: A Korean Population-Based Study.
机构信息
Division of Endocrinology and Metabolism, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
出版信息
Endocrinol Metab (Seoul). 2022 Apr;37(2):281-289. doi: 10.3803/EnM.2021.1333. Epub 2022 Apr 6.
BACKGROUND
Hyperthyroidism is associated with an increased glomerular filtration rate (GFR) in the hyperdynamic state, which is reversible after restoring euthyroidism. However, long-term follow-up of renal dysfunction in patients with hyperthyroidism has not been performed.
METHODS
This was a retrospective cohort study using the Korean National Health Insurance database and biannual health checkup data. We included 41,778 Graves' disease (GD) patients and 41,778 healthy controls, matched by age and sex. The incidences of end-stage renal disease (ESRD) were calculated in GD patients and controls. The cumulative dose and duration of antithyroid drugs (ATDs) were calculated for each patient and categorized into the highest, middle, and lowest tertiles.
RESULTS
Among 41,778 GD patients, 55 ESRD cases occurred during 268,552 person-years of follow-up. Relative to the controls, regardless of smoking, drinking, or comorbidities, including chronic kidney disease, GD patients had a 47% lower risk of developing ESRD (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.37 to 0.76). In particular, GD patients with a higher baseline GFR (≥90 mL/min/1.73 m2; HR, 0.33; 95% CI, 0.11 to 0.99), longer treatment duration (>33 months; HR, 0.31; 95% CI, 0.17 to 0.58) or higher cumulative dose (>16,463 mg; HR, 0.29; 95% CI, 0.15 to 0.57) of ATDs had a significantly reduced risk of ESRD.
CONCLUSION
This was the first epidemiological study on the effect of GD on ESRD, and we demonstrated that GD population had a reduced risk for developing ESRD.
背景
在高动力状态下，甲状腺功能亢进症与肾小球滤过率（GFR）升高有关，在恢复甲状腺功能正常后可逆转。然而，对于甲状腺功能亢进症患者肾功能障碍的长期随访尚未进行。
方法
这是一项使用韩国国家健康保险数据库和两年一次健康检查数据的回顾性队列研究。我们纳入了 41778 例格雷夫斯病（GD）患者和 41778 名健康对照者，按年龄和性别进行匹配。计算 GD 患者和对照组终末期肾病（ESRD）的发生率。计算每位患者的抗甲状腺药物（ATD）累积剂量和持续时间，并分为最高、中、低三分位。
结果
在 41778 例 GD 患者中，在 268552 人年的随访期间发生了 55 例 ESRD 病例。与对照组相比，无论是否吸烟、饮酒或合并症，包括慢性肾脏病，GD 患者发生 ESRD 的风险降低 47%（风险比[HR]，0.53；95%置信区间[CI]，0.37 至 0.76）。特别是，基线 GFR 较高（≥90 mL/min/1.73 m2；HR，0.33；95%CI，0.11 至 0.99）、治疗时间较长（>33 个月；HR，0.31；95%CI，0.17 至 0.58）或 ATD 累积剂量较高（>16463mg；HR，0.29；95%CI，0.15 至 0.57）的 GD 患者发生 ESRD 的风险显著降低。
结论
这是第一项关于 GD 对 ESRD 影响的流行病学研究，我们表明 GD 人群发生 ESRD 的风险降低。
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