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Received:November 22, 2022 Published Online:November 20, 2023
Received:November 22, 2022 Published Online:November 20, 2023
中文摘要: 目的 探讨在2型糖尿病（T2DM）患者中,亚临床甲状腺功能异常与糖尿病肾病（DKD）的相关性。方法 采用回顾性研究方法,选取2019年1月至2021年3月于吉林省一汽总医院住院的T2DM患者276例,其中DKD者154例和非DKD者122例。所有患者计算身体质量指数（BMI）,检测血清糖化血红蛋白（HbAlc）、甲状腺素（TT4）、总三碘甲状腺原氨酸（TT3）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）及促甲状腺激素（TSH）的水平等。根据甲状腺功能分为甲状腺功能正常组（188例）、亚临床甲状腺功能减退症(SCHypo)组(63例)及亚临床甲状腺功能亢进症(SCHyper)组(25例)，采用多因素logistic回归分析DKD的影响因素。结果 与非DKD患者相比，DKD患者病程长，并有较高的BMI、空腹血糖、胱抑素C（Cys C）、血尿酸、三酰甘油和TSH水平（P＜0.05）。DKD的患病率在甲状腺功能正常组为54.3%（102例），在SCHypo组为69.8%（44例），差异有统计学意义（χ2=4.711，P=0.038）；在SCHyper组为32.0%（8例），较甲状腺功能正常组下降（χ2=4.376，P=0.036）。TSH（OR＝0.908, 95%CI：0.838～0.985, P＜0.05）和SCHypo（OR＝1.060, 95%CI：1.020～1.101, P＜0.05）为DKD患病的独立影响因素。结论 TSH和SCHypo可能为T2DM患者发生DKD的独立影响因素。
中文关键词: 2型糖尿病 亚临床甲状腺功能减退症 亚临床甲状腺功能亢进症 糖尿病肾病 游离甲状腺素
Abstract:Objective To investigate the correlation between subclinical thyroid dysfunction and diabetic kidney disease （DKD） in the patients with type 2 diabetes mellitus （T2DM）. Methods A retrospective analysis was performed on 276 T2DM patients treated in Jilin Province FAW General Hospital from January 2019 to March 2021, including 154 patients with DKD and 122 patients without DKD （control group）. The body mass index （BMI）, glycated hemoglobin （HbA1c）, serum total thyroxine （TT4）, total triiodothyronine （TT3）, free triiodothyronine （FT3）, free thyroxine （FT4） and thyroid-stimulating hormone （TSH） were measured and detected for all patients. The patients were further divided into normal thyroid function group （n=188）, subclinical hypothyroidism （SCHypo） group （n=63） and subclinical hyperthyroidism （SCHyper） group （n=25） according to thyroid function. The influencing factors of DKD was analyzed by multivariate logistic regression. Results Compared with non DKD patients, DKD patients had a longer course of disease and higher levels of BMI, fasting blood glucose, Cystatin C, serum uric acid, triglyceride, and TSH (P＜0.05). The incidence of DKD was 54.3% (102 cases) in the normal thyroid function group and 69.8% (44 cases) in the SCHypo group, the difference had statistical significance (χ2=4.711，P=0.038), in the SCHyper group, 32.0% (8 cases) showed a significant decrease compared to the normal thyroid function group (χ2=4.376，P=0.036). The logistic regression analysis showed that TSH(OR=0.908, 95%CI:0.838-0.985, P＜0.05) and SCHypo（OR=1.060, 95%CI:1.020-1.101, P＜0.05） were independent factors of DKD. Conclusion TSH level and SCHypo may be independent influencing factors of DKD in T2DM patients.
keywords: Type 2 diabetes mellitus Subclinical hypothyroidism Subclinical hyperthyroidism Diabetic kidney disease Free thyroxine
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基金项目:吉林省自然科学基金资助项目（20200201587JC）
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