Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Research Institute of Nephrology, Zhengzhou University, Zhengzhou, Henan, China.
Front Endocrinol (Lausanne). 2023 Mar 16;14:1133521. doi: 10.3389/fendo.2023.1133521. eCollection 2023.
Thyroid dysfunction is common in patients with kidney disease. However, the relationship between thyroid dysfunction and idiopathic membranous nephropathy (IMN) remains unclear. This retrospective study aimed to investigate the clinicopathological characteristics and prognosis of patients with IMN and thyroid dysfunction compared to patients with IMN and without thyroid dysfunction.
A total of 1052 patients with IMN diagnosed by renal biopsy were enrolled in this study, including 736 (70%) with normal thyroid function and 316 (30%) with abnormal thyroid function. We analyzed the clinicopathological features and prognostic data between the two groups, using propensity score matching (PSM) to reduce the bias. Logistic regression analysis was performed to investigate the risk factors for IMN combined with thyroid dysfunction. Kaplan-Meier curves and Cox regression analysis were used to evaluate the association between thyroid dysfunction and IMN.
Patients with IMN and thyroid dysfunction exhibited more severe clinical features. Female sex, lower albumin level, higher D-dimer level, severe proteinuria, and decreased estimated glomerular filtration rate were predictors of thyroid dysfunction in patients with IMN. After PSM, 282 pairs were successfully matched. Results from the Kaplan-Meier curves indicated that the thyroid dysfunction group had a lower complete remission rate ( = 0.044), higher relapse rate ( < 0.001), and lower renal survival rate ( = 0.004). The multivariate Cox regression analysis revealed that thyroid dysfunction was an independent risk factor for complete remission [hazard ratio (HR) = 0.810, = 0.045], relapse (HR = 1.721, = 0.001), and composite endpoint event (HR = 2.113, = 0.014) in IMN.
Thyroid dysfunction is relatively common in patients with IMN, and the clinical indicators are more severe in these patients. Thyroid dysfunction is an independent risk factor for poor prognosis in patients with IMN. More attention should be paid to thyroid function in patients with IMN.
甲状腺功能障碍在肾病患者中很常见。然而，甲状腺功能障碍与特发性膜性肾病（IMN）之间的关系尚不清楚。本回顾性研究旨在探讨与甲状腺功能正常的 IMN 患者相比，甲状腺功能异常的 IMN 患者的临床病理特征和预后。
本研究共纳入 1052 例经肾活检诊断为 IMN 的患者，其中 736 例（70%）甲状腺功能正常，316 例（30%）甲状腺功能异常。我们分析了两组患者的临床病理特征和预后数据，并采用倾向评分匹配（PSM）以减少偏倚。采用 logistic 回归分析探讨 IMN 合并甲状腺功能障碍的危险因素。采用 Kaplan-Meier 曲线和 Cox 回归分析评估甲状腺功能障碍与 IMN 之间的关系。
IMN 合并甲状腺功能障碍的患者临床表现更严重。女性、白蛋白水平较低、D-二聚体水平较高、大量蛋白尿和估算肾小球滤过率降低是 IMN 患者甲状腺功能障碍的预测因素。PSM 后，成功匹配 282 对。Kaplan-Meier 曲线结果表明，甲状腺功能障碍组完全缓解率较低（ = 0.044），复发率较高（ < 0.001），肾脏生存率较低（ = 0.004）。多因素 Cox 回归分析显示，甲状腺功能障碍是 IMN 完全缓解（危险比[HR] = 0.810， = 0.045）、复发（HR = 1.721， = 0.001）和复合终点事件（HR = 2.113， = 0.014）的独立危险因素。
甲状腺功能障碍在 IMN 患者中较为常见，且这些患者的临床指标更为严重。甲状腺功能障碍是 IMN 患者预后不良的独立危险因素。在 IMN 患者中应更加关注甲状腺功能。
