糖尿病肾病患者血清甲状腺激素水平变化及其相关性研究

目的 探讨糖尿病肾病患者肾功能状况与甲状腺功能的关系.方法 选取确诊的糖尿病患者共132例作为研究组,并选取我院健康的体检者40例,作为对照组,研究组剔除4例临床甲状腺功能亢进、2例临床甲状腺功能减退患者后,剩余126例糖尿病患者分别按照尿白蛋白排泄率(UAER)(2周内查3次取均值)、肾小球滤过率(GFR)分组,比较不同肾病组间游离T3(FT3)、游离T4(FT4)、促甲状腺激素(TSH)水平的差异.结果 随着糖尿病肾病病情的加重,FT3有逐渐下降的趋势,按UAER所分各组间差异无统计学意义(P＞0.05)；按GFR所分各组中GFR≤30 ml/min组、GFR 31～60 ml/min组的FT3低于GFR≥90 ml/min组[(2.53±0.88)、(2.63±0.83) pmol/L比(3.14 ±0.64) pmol/L,P＜0.05]；FT4、TSH所有分组中均无统计学意义(P＞0.05).结论 糖尿病肾病患者存在不同程度的甲状腺激素水平降低,且随着糖尿病肾病病情的加重,临床肾病期甲状腺功能趋向于亚临床甲状腺功能减退状态,而终末期肾病甲状腺功能趋向于低T3综合征.

Research on the change and correlations of serum thyroid hormone levels in patients with diabetic nephropathy

Objective To explore the relationship between the renal function and thyroid function in the patients with diabetic nephropathy. Methods One hundred and thirty-two patients with diabetes mellitus （DM） from December to September 2009 at the Second Affiliated Hospital of Baotou Medical College were selected. 40 healthy volunteers from June to September 2010 were selected as controls. 4 patients with clinical hyperthyroidism and 2 patients with clinical hypothyroidism were excluded from the 132 subjects included. The remaining 126 patients with DM were divided into groups according to urinary albumin excretion rate （UAER） （ examined three times within two weeks） and glomerular filtration rate（GFR） respectively. The differences of free tri-iodothyronine （FT3 ） , free thyroxine （ FT4 ） , and thyroid-stimulating hormone （TSH） levels were compared respectively. Results The more serious diabetic nephropathy was, the lower FT3 level was. Levels of FT3 based on UAER had no statistical differences （P 〉0. 05） ; FT of 3GFR, ≤ 30 ml/min groupand GFR 31 to 60 ml / rain group were lower than that of GFR ≥ 90 ml/min group [ （ 2. 53 ± 0. 88 ）, （ 2. 63 ± 0. 83 ） pmol/L vs （ 3.14 ± 0. 64 ） pmol/L, P 〈 0.05 ] ; levels of FT4 and TSH among all the groups had no statistical differences （P 〉 0. 05 ）. Conclusions The thyroid hormone levels of patients with diabetic nephropathy are reduced in various degrees. Thyroid function of patients who were at the clinical nephropathy stage is likely to be subclinical hypothyroidism as diabetic nephropathy gets worse.