Ma Dengrong, Zhao Pingping, Gao Jie, Guo Xinyuan, Han Mei, Zan Xiaohui, Chen Chongyang, Lv Xiaoyu, Liu Jingfang
The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, People's Republic of China.
Department of Endocrinology, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 Apr 23;18:1207-1221. doi: 10.2147/DMSO.S507750. eCollection 2025.
To investigate the association between impaired thyroid hormone sensitivity and diabetic nephropathy (DN) in euthyroid patients with type 2 diabetes mellitus (T2DM).
1305 euthyroid patients with T2DM who were hospitalized in the Endocrinology Department of the First Hospital of Lanzhou University between July 2021 and August 2023 were selected. Several indices, such as the parameters thyroid feedback quantile index (PTFQI), thyroid feedback quantile index (TFQI), thyroid stimulating hormone index (TSHI), serum-free triiodothyronine to free thyroxine (FT3/FT4) ratio, and thyrotropin thyroxine resistance index (TT4RI) to evaluate thyroid hormone sensitivity were used. The patients were subdivided into four groups ( to ) based on the quartile levels of the five indices. The correlation between thyroid hormone sensitivity and DN was analyzed by binary logistic regression and restricted cubic spline (RCS) analysis.
The levels of PTFQI, TFQI, and TSHI in the DN group were higher than those in the Non-DN group [0.04(-0.21, 0.31) vs -0.003(-0.27, 0.25), 0.05(-0.20, 0.30) vs 0.006(-0.26, 0.25), 2.54±0.52 vs 2.47±0.51, all <0.05], while the FT3/FT4 levels were decreased in the DN group (0.40±0.07 vs 0.42±0.07, <0.05). Multivariate logistic regression analysis showed that the increase in PTFQI and TFQI levels was positively correlated with DN [OR=1.518, 95% CI(1.074, 2.145) and OR=1.546, 95% CI(1.084, 2.204)]. RCS showed a linear dose-response relationship between PTFQI, TFQI, TSHI, FT3/FT4, TT4RI, and the tendency of DN (all >0.05). As the levels of PTFQI, TFQI, and TSHI increased, and the FT3/FT4 levels decreased, the prevalence of DN and the urinary albumin-to-creatinine (UACR) level showed an upward trend (all <0.05), while the estimated glomerular filtration rate (eGFR) level showed a downward trend (all <0.05).
Among euthyroid patients with T2DM, impaired thyroid hormone sensitivity is associated with DN, as well as elevated UACR levels and decreased eGFR levels.
探讨甲状腺激素敏感性受损与甲状腺功能正常的2型糖尿病（T2DM）患者糖尿病肾病（DN）之间的关联。
选取2021年7月至2023年8月在兰州大学第一医院内分泌科住院的1305例甲状腺功能正常的T2DM患者。使用了几个指标，如甲状旁腺反馈分位数指数（PTFQI）、甲状腺反馈分位数指数（TFQI）、促甲状腺激素指数（TSHI）、血清游离三碘甲状腺原氨酸与游离甲状腺素（FT3/FT4）比值以及促甲状腺激素甲状腺素抵抗指数（TT4RI）来评估甲状腺激素敏感性。根据这五个指标的四分位数水平将患者分为四组（ 至 ）。通过二元逻辑回归和受限立方样条（RCS）分析甲状腺激素敏感性与DN之间的相关性。
DN组的PTFQI、TFQI和TSHI水平高于非DN组[0.04（-0.21，0.31）对-0.003（-0.27，0.25），0.05（-0.20，0.30）对0.006（-0.26，0.25），2.54±0.52对2.47±0.51，均<0.05]，而DN组的FT3/FT4水平降低（0.40±0.07对0.42±0.07，<0.05）。多因素逻辑回归分析显示，PTFQI和TFQI水平升高与DN呈正相关[比值比（OR）=1.518，95%置信区间（CI）（1.074，2.145）；OR=1.546，95%CI（1.084，2.204）]。RCS显示PTFQI、TFQI、TSHI、FT3/FT4、TT4RI与DN倾向之间存在线性剂量反应关系（均>0.05）。随着PTFQI、TFQI和TSHI水平升高以及FT3/FT4水平降低，DN患病率和尿白蛋白与肌酐（UACR）水平呈上升趋势（均<0.05），而估算肾小球滤过率（eGFR）水平呈下降趋势（均<0.05）。
在甲状腺功能正常的T2DM患者中，甲状腺激素敏感性受损与DN以及UACR水平升高和eGFR水平降低有关。
