血清促甲状腺激素和甲状腺激素水平与糖尿病肾病的相关性：一项横断面研究。

Correlation of serum thyrotropin and thyroid hormone levels with diabetic kidney disease: a cross-sectional study.

机构信息

The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China.

Department of Endocrinology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China.

出版信息

BMC Endocr Disord. 2024 Aug 30;24(1):170. doi: 10.1186/s12902-024-01699-x.

DOI:10.1186/s12902-024-01699-x

PMID:39215277

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11363369/

Abstract

OBJECTIVE

The relationship between thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and diabetic kidney disease (DKD) is still controversial, and this study analyzed the correlation between TSH, FT3, FT4 and DKD in patients with type 2 diabetes mellitus (T2DM).

METHODS

T2DM patients (1216) were divided into five groups based on serum TSH, FT3, and FT4 levels, differences in urinary albumin excretion rate (UACR), estimated glomerular filtration rate (eGFR) were compared. Binary logistic regression verified independent correlations among TSH, FT3, FT4 and UACR, eGFR. TSH and FT3 predictive values for DKD were analyzed using receiver operating characteristic (ROC) curves.

RESULTS

The prevalence of albuminuria with decreased eGFR was higher in T2DM patients with subclinical hypothyroidism and overt hypothyroidism than that in patients with normal thyroid function. TSH positively correlated with UACR (r = 0.133, p < 0.001) and positively correlated with eGFR (r = -0.218, p < 0.001), FT3 negatively correlated with UACR (r = -0.260, p < 0.001) and positively correlated with eGFR (r = 0.324, p < 0.001). With the change from the lower normal level to the increased level of TSH and the change from the higher normal level to the reduced level of FT3, the prevalence of albuminuria gradually increased, the prevalence of decreased eGFR gradually increased in TSH groups and FT3 groups. After adjusting for age, BMI, duration of diabetes, TPOAb, TGAb, smoking, drinking, hypertension, the use of anti-diabetic medications (metformin, sodium-glucose cotransporter 2 inhibitors), HbA1c, CRP, TC, TG, LDL-C, and HDL-C, both TSH and FT3 correlated with increased UACR (TSH: OR 1.253, p = 0.001; FT3: OR 0.166, p < 0.001) and decreased eGFR (TSH: OR 1.245, p < 0.001, FT3: OR 0.579, p < 0.001), but this correlation of TSH with eGFR < 60 mL/min/1.73 m was not found in male. The area under the ROC curve (AUC) for FT3 was greater than that for TSH (FT3: 0.64; TSH: 0.61).

CONCLUSIONS

Increased TSH and reduced FT3 levels were associated with DKD in T2DM patients, but in a sex-dependent manner. FT3 had a higher predictive value for DKD.

摘要

目的

促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）与糖尿病肾病（DKD）的关系仍存在争议，本研究旨在分析 2 型糖尿病（T2DM）患者 TSH、FT3、FT4 与 DKD 的相关性。

方法

根据血清 TSH、FT3 和 FT4 水平，将 1216 例 T2DM 患者分为五组，比较各组间尿白蛋白排泄率（UACR）、估算肾小球滤过率（eGFR）的差异。采用二元逻辑回归验证 TSH、FT3、FT4 与 UACR、eGFR 的独立相关性。采用受试者工作特征（ROC）曲线分析 TSH 和 FT3 对 DKD 的预测价值。

结果

亚临床甲状腺功能减退症和显性甲状腺功能减退症患者的白蛋白尿合并 eGFR 降低的患病率高于甲状腺功能正常的患者。TSH 与 UACR 呈正相关（r=0.133，p<0.001），与 eGFR 呈负相关（r=-0.218，p<0.001），FT3 与 UACR 呈负相关（r=-0.260，p<0.001），与 eGFR 呈正相关（r=0.324，p<0.001）。随着 TSH 从正常低值到升高，FT3 从正常高值到降低，TSH 组和 FT3 组的白蛋白尿患病率逐渐增加，eGFR 降低的患病率逐渐增加。校正年龄、BMI、糖尿病病程、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）、吸烟、饮酒、高血压、降糖药物（二甲双胍、钠-葡萄糖共转运蛋白 2 抑制剂）、糖化血红蛋白（HbA1c）、C 反应蛋白（CRP）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）后，TSH 和 FT3 均与 UACR 增加相关（TSH：OR 1.253，p=0.001；FT3：OR 0.166，p<0.001）和 eGFR 降低相关（TSH：OR 1.245，p<0.001，FT3：OR 0.579，p<0.001），但在男性中未发现 TSH 与 eGFR<60 mL/min/1.73 m 的相关性。FT3 的 ROC 曲线下面积（AUC）大于 TSH（FT3：0.64；TSH：0.61）。