2型糖尿病患者参考范围甲状腺激素与糖尿病肾病的相关性分析

目的:探讨甲状腺功能正常的2型糖尿病患者甲状腺激素与血糖控制及糖尿病肾病(diabetic kidney disease,DKD)的关系。方法:收集240例年龄≥45岁甲状腺功能正常的2型糖尿病患者临床及实验室资料,分析甲状腺激素与血糖控制及DKD的关系。结果:糖化血红蛋白(hemoglobin A1c,HbA1c)分别与总三碘甲状腺原氨酸(total triiodothyronine,TT3)(r=-0.183,P<0.01)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)(r=-0.221,P<0.01)呈显著负相关。将TT3、FT3、总甲状腺素(total thyroxine,TT4)、游离甲状腺素(free thyroxine,FT4)以四分位法分为4组,以促甲状腺激素(thyroid stimulating hormone,TSH)2.5 mU/L为界分为2组,发现FT3-Q1(2.94~3.52)、FT3-Q2(3.53~3.84)组DKD的患病率分别显著高于FT3-Q4(4.11~4.81)组(FT3-Q1比FT3-Q4χ^2=9.636,P<0.01;FT3-Q2比FT3-Q4χ^2=5.227,P<0.05)。TT3-Q1(0.33~1.27)组DKD的患病率显著高于TT3-Q4(1.54~1.94)组(χ^2=7.557,P<0.01)。多元Logistic回归分析显示,与FT3-Q4组相比,FT3-Q1、FT3-Q2组发生DKD的危险性显著升高[优势比(odds ratio,OR)=5.132,95%可信区间(confidence interval,CI):1.561~16.872,P<0.01;OR=3.775(95%CI:1.131~12.596),P<0.05]。结论:甲状腺功能正常的2型糖尿病患者体内FT3可反映血糖控制情况。参考范围内低水平的FT3与DKD的高患病率显著相关,为DKD的危险因素。

Association between thyroid hormone levels and diabetic kidney disease in euthyroid patients with type 2 diabetes

Objective To investigate the relationship between thyroid hormone levels and blood glucose and diabetic nephropathy in euthyroid subjects with type 2 diabetes mellitus.Methods The cross-sectional study included 240 type 2 diabetes mellitus patients over 45 years old with normal thyroid function from March 2015 through December 2018.The laboratory data include fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),hemoglobin A1c(HbA1c),total triiodothyronine(TT3),total thyroxine(TT4),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb)and thyroglobulin autoantibodies(TGAb)were acquired.Univariate ANOVA analysis,Pearson/Spearman correlation analysis and binary Logistic regression were used to analyze the relationship between thyroid hormone levels and blood glucose level and diabetic nephropathy in patients negative for thyroid autoimmune antibodies.Results HbA1c was negatively correlated with TT3 and FT3.The numerical data of TT3,FT3,TT4 and FT4 assay were divided into quartiles and converted into categorical data.TSH was divided into two groups with TSH=2.5 mU/L as the cut-off value.Compared with FT3-Q4(4.11-4.81)group,the prevalence of diabetic nephropathy in FT3-Q1(2.94-3.52)and FT3-Q2(3.53-3.84)increased significantly(χ^2=9.636,P<0.01;χ^2=5.227;P<0.05).Compared with TT3-Q4(1.54-1.94)group,the prevalence of diabetic nephropathy in TT3-Q1(0.33-1.27)group was significantly higher(χ^2=7.557,P<0.01).Logistic regression analysis showed significantly increased risk of diabetic nephropathy in FT3-Q1 and FT3-Q2 groups than in FT3-Q4 group[odds ratio(OR)=5.132,95%confidence interval(CI):1.561-16.872,P<0.01;OR=3.775(95%CI:1.131-12.596),P<0.05].Conclusions FT3 is correlated with blood glucose level and the severity of diabetes mellitus,with low level of FT3 in reference r range associated with high prevalence of diabetic nephropathy,and may constitutes an independent risk factor for diabetic nephropathy.