糖尿病肾病患者血清甲状腺激素水平变化及其与亚临床甲状腺功能减退的相关性

目的 探讨糖尿病肾病(diabetic kidney disease,DKD)患者血清甲状腺激素水平变化及其与亚临床甲状腺功能减退(SCH)的相关性。方法测定160例2型糖尿病(T2DM)患者(T2DM组)及50例健康体检者(C组)的空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)、肌酐(Cr)、尿素氮(BUN)及血清游离甲状腺激素(FT4)、游离三碘甲状腺原氨酸(FT3)和促甲状腺激素(TSH)等甲状腺激素指标,并收集24 h尿液进行尿微量蛋白测定。根据尿蛋白排泄率(UAER)将T2DM分为3个亚组:单纯糖尿病组(SDM组,n=50)、早期糖尿病肾病组(EDKD组,n=67)和临床糖尿病肾病组(CDKD组,n=43)。比较各组甲状腺激素水平变化及SCH的发生率,分析SCH对DKD的影响。结果 各组HbAlc,FPG,2hPG,Cr,BUN,UAER及eGFR比较,差异有统计学意义(t=19.64～1 267.22,均P<0.001)。与C组、SDM组比较,EDKD组、CDKD组FT3和FT4水平明显降低,TSH水平明显升高,差异均有统计学意义(t=3.17～4.69,2.67～2.94,3.05～3.47,均P<0.05)。EDKD组、CDKD组FT3和FT4水平差异无统计学意义(t=0.78,0.82,均P>0.05),TSH水平则有显著性差异(t=3.19,P<0.05)。随着肾功能损害的加重,SCH发生率明显升高,差异有统计学意义(F=8.01,P<0.05)。多因素logistics回归分析显示,糖尿病病程、HbAlc,FT3及SCH是DKD发病的独立危险因素(OR=1.89～3.77,P<0.05)。结论 DKD患者存在不同程度甲状腺功能异常,SCH与DKD的发生、发展密切相关。

Correlation between Serum Thyroid Hormone Levels in Patients with Diabetic Kidney Disease and Subclinical Hypothyroidism

Objective To explore the change of serum thyroid hormone levels in patients with diabetic kidney disease(DKD)and its correlation with subclinical hypothyroidism(SCH).Methods FPG,2h PG,HbAlc,Cr,BUN,and thyroid hormones including T3,T4,TSH were detected in 160 patients with type 2 diabetes mellitus(T2DM)and 50 healthy people.Thesepatients were divided into three groups according to the urine albumin excretion rate(UAER)including simple diabetic group(SDM group,n=50),early diabetic nephropathy group(EDKD group,n=67)and clinical diabetic nephropathy group(CDKD group,n=43).The changes of thyroid hormone levels and the incidence rate of SCH in each group were compared,and the effect of SCH on DKD was analyzed.Results There were significant different on the levels of HbAlc,FPG,2 h PG,Cr,BUN,UAER and eGFR among each group(t=19.64～1267.22,all P<0.001).Compared with C group and SDM group,levels of FT3,FT4 and TSH in EDKD group and CDKD group were significantly reduced,and TSHwas increased(t=3.17～4.69,2.67～2.94 and 3.05～3.47,all P<0.05).There was no significant difference between EDKD group and CDKD group on FT3,FT4 levels(t=0.78 and 0.82,all P>0.05),while the TSH level had significant difference(t=3.19,P<0.05).With the aggravation of renal function damage,the incidence of SCH was increased significantly(F=8.01,P<0.05).Multivariate logistic regression analysis showed that the HbAlc,FT3 and SCHwere independent risk factors for occurrence of DKD(OR=1.89～3.77,P<0.05).Conclusion DKD had different degrees of thyroid dysfunction,and SCH are closely related to the occurrence and development of DKD.