Liu Xue, Zhang Yuhao, Li Yuchen, Fan Xiude, Zhang Haiqing
Department of Endocrinology, Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
Department of Urology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, 250021, China.
BMC Public Health. 2025 Aug 9;25(1):2715. doi: 10.1186/s12889-025-23695-z.
To evaluate the relationship between thyroid function and thyroid homeostasis parameters with the prevalence of chronic kidney disease (CKD) and furtherly explore the all-cause and cardiovascular mortality among individuals with CKD using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2012.
This study included 8,526 adults, including 1,625 patients with CKD. Thyroid function included serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH). The thyroid homeostasis parameters, including FT3/FT4, thyroid feedback quantile-based index (TFQI, TFQI), thyrotrophic thyroxine resistance index (TT4RI, TT3RI) and thyroid-stimulating hormone index (TSHI) were calculated. Weighted multivariate logistic regression models to explore the association between thyroid function and thyroid homeostasis parameters and the prevalence of CKD. Cox proportional hazards models were used to investigate the association of thyroid function and thyroid homeostasis parameters with all-cause and cardiovascular mortality among CKD patients. Kaplan-Meier curves compared survival across the quartiles of the thyroid function and thyroid homeostasis parameters among CKD patients. Furthermore, the restricted cubic splines were used to explore the non‑linear relationships.
The weighted multivariate logistic regression models showed that FT4 was positively correlated with the prevalence of CKD, FT3/FT4 and TFQI were negatively correlated with mortality in patients with CKD. The Cox regression models 3 shows that the multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of FT3, FT4 and TSH with the all-cause mortality were 0.66(0.47,0.93), 1.07(1.04,1.10) and 1.01(0.98,1.04). At the same time, FT3/FT4 and TFQI were significantly associated with all-cause mortality after multivariate adjustment. And we further converted thyroid function indicators and thyroid homeostasis parameters from a continuous variable to a categorical variable (quartiles) to conduct the sensitivity analysis. There was no difference in cardiovascular mortality. In crude Kaplan-Meier analyses, there was a U-shaped nonlinear relationship between FT3, TSH, FT3/FT4, TT4RI, TT3RI and TSHI with all-cause mortality, but not FT4, TFQI and TFQI. There was an inverted U-shaped relationship between TFQI and TT4RI with cardiovascular mortality, but not FT3, FT4, TSH, FT3/FT4, TFQI, TT3RI and TSHI.
Thyroid function and thyroid parameters are closely related to the prevalence of the CKD and all-cause and cardiovascular mortality among individuals with CKD, and the specific mechanisms still required further in-depth research in the future.
利用2007 - 2012年美国国家健康与营养检查调查（NHANES）的数据，评估甲状腺功能和甲状腺内环境稳定参数与慢性肾脏病（CKD）患病率之间的关系，并进一步探讨CKD患者的全因死亡率和心血管死亡率。
本研究纳入8526名成年人，其中包括1625例CKD患者。甲状腺功能指标包括血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）。计算甲状腺内环境稳定参数，包括FT3/FT4、基于甲状腺反馈分位数的指数（TFQI）、促甲状腺素甲状腺素抵抗指数（TT4RI、TT3RI）和促甲状腺激素指数（TSHI）。采用加权多因素逻辑回归模型探讨甲状腺功能和甲状腺内环境稳定参数与CKD患病率之间的关联。采用Cox比例风险模型研究甲状腺功能和甲状腺内环境稳定参数与CKD患者全因死亡率和心血管死亡率之间的关联。Kaplan-Meier曲线比较了CKD患者甲状腺功能和甲状腺内环境稳定参数四分位数的生存率。此外，使用受限立方样条来探索非线性关系。
加权多因素逻辑回归模型显示，FT4与CKD患病率呈正相关，FT3/FT4和TFQI与CKD患者死亡率呈负相关。Cox回归模型3显示，FT3、FT4和TSH与全因死亡率的多因素调整风险比（HRs）及95%置信区间（CIs）分别为0.66（0.47，0.93）、1.07（1.04，1.10）和1.01（0.98，1.04）。同时，FT3/FT4和TFQI在多因素调整后与全因死亡率显著相关。我们进一步将甲状腺功能指标和甲状腺内环境稳定参数从连续变量转换为分类变量（四分位数）进行敏感性分析。心血管死亡率无差异。在粗Kaplan-Meier分析中，FT3、TSH、FT3/FT4、TT4RI、TT3RI和TSHI与全因死亡率之间存在U型非线性关系，但FT4、TFQI和TFQI不存在。TFQI和TT4RI与心血管死亡率之间存在倒U型关系，但FT3、FT4、TSH、FT3/FT,、TFQI、TT3RI和TSHI不存在。
甲状腺功能和甲状腺参数与CKD的患病率以及CKD患者的全因死亡率和心血管死亡率密切相关，具体机制仍有待未来进一步深入研究。
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