摘要
目的探讨亚临床甲状腺功能减退症(SCH)对2型糖尿病(T2DM)患者早期肾脏疾病进展的影响。方法对2008年1月至2018年8月于天津医科大学代谢病医院多次住院治疗且预估肾小球滤过率(eGFR)大于60 ml·min^-1·1.73 m^-2的260例T2DM早期肾脏疾病患者进行回顾性分析,其中T2DM合并甲功正常组(DM+EUT组)198例,T2DM合并SCH者(DM+SCH组)62例。将首次住院的时间作为研究起点,之后每次住院均视为随访,最后一次住院时间作为研究的终点,收集每次住院时临床资料及肾脏功能指标,比较DM+SCH组和DM+EUT组平均每年肾小球滤过率下降速度(eGFR/Y)、平均每年24 h尿总蛋白(24 h-TP/Y)及微量白蛋白增长速度(24 h-UMA/Y)。采用Pearson或Spearman相关性分析及多元线性回归分析eGFR/Y的影响因素。结果两组患者基线血尿素氮、肌酐、尿酸比较,差异无统计学意义(t=-0.692、-1.432、-0.987,P>0.05),两组基线24 h尿总蛋白(24 h-TP)、24 h尿微量白蛋白(24 h-UMA)比较,差异无统计学意义(Z=-1.536、-1.412,P>0.05)。DM+SCH组基线eGFR较DM+EUT组有减低趋势,但差异无统计学意义[(96.5±41.9)比(99.4±42.2)ml·min^-1·(1.73 m^2)-1,t=1.695,P=0.095]。DM+SCH组eGFR/Y高于DM+EUT组[6.02(2.31,8.92)比4.32(1.35,6.01)ml·min^-1·(1.73 m^2)-1,Z=-2.241,P=0.020]。两组24 h-TP/Y和24 h-UMA/Y比较,无明显差异(Z=-1.536、-1.412,P>0.05)。多元线性回归分析显示,在校正24 h-TP、收缩压、基线eGFR的影响后,促甲状腺激素(TSH)仍与eGFR/Y独立相关(t=2.149,P=0.036)。结论TSH是平均eGFR/Y的独立危险因素,SCH可加快T2DM早期糖尿病肾脏疾病的进展。
Objective To investigate the effect of subclinical hypothyroidism(SCH)on the progression of early diabetic kidney disease(DKD)in type 2 diabetic patients.Methods A retrospective study was performed in 260 patients with early type 2 diabetic kidney disease[estimated glomerular filtration rate(eGFR)greater than 60 ml·min^-1·(1.73 m^2)-1],who were repeatedly hospitalized in Tianjin Medical University Metabolic Diseases Hospital for more than 3 times from January 2008 to August 2018,including 198 patients with normal thyroid function and 62 patients with subclinical hypothyroidism.The first hospitalization was defined as the starting point,the last hospitalization was defined as the study endpoint.According to the levels of thyroid-stimulating hormone(TSH),free triiodothyronine and free thyroxine,the patients were divided into two groups:type 2 diabetes with normal thyroid function group(DM+EUT)and type 2 diabetes with subclinical hypothyroidism group(DM+SCH).The clinical data and renal function indicators of each hospitalization were collected.The average annual decreasing rate of eGFR(eGFR/Y),the average annual increasing rate of 24-hour total urine protein(24 h-TP/Y)and 24-hour urine microprotein(24 h-UMA/Y)were compared between these two groups.The influence factors of eGFR/Y were analyzed by Pearson or Spearman correlation and multiple linear regression.Results There were no significant differences in baseline blood urea nitrogen,serum creatinine,uric acid between these two groups(t=-0.692,-1.432,-0.987,respectively,P>0.05).There were no statistical differences in the 24 h-TP and 24 h-UMA between these two groups(Z=-1.536,-1.412,P>0.05).The baseline eGFR in the DM+SCH group was lower than that in the DM+EUT group[(96.5±41.9)vs(99.4±42.2)ml·min^-1·(1.73 m^2)-1,t=1.695,P=0.095],but the difference had no statistical significant.The eGFR/Y in the DM+SCH group was significantly higher than that in the DM+EUT group[6.02(2.31,8.92)vs 4.32(1.35,6.01)ml·min^-1·(1.73 m^2)-1,Z=-2.241,P=0.02].There was no significant difference in 24 h-TP/Y and 24 h-UMA/Y between these two groups(P>0.05).After adjustment for potential confounding factors(24 h-TP,systolic blood pressure and baseline eGFR)by multiple linear regression analysis,TSH remained to be associated with eGFR/Y significantly(t=2.149,P=0.036).Conclusion TSH is an independent risk factor for the average annual decreasing rate of eGFR.SCH can accelerate the progression of early DKD in type 2 diabetic patients.
作者
程静丽
郑妙艳
单春艳
杨艳辉
杨菊红
王靖宇
任惠珠
常宝成
Cheng Jingli;Zheng Miaoyan;Shan Chunyan;Yang Yanhui;Yang Juhong;Wang Jingyu;Ren Huizhu;Chang Baocheng(NHC Key Laboratory of Hormones and Development(Tianjin Medical University),Tianjin Key Laboratory of Metabolic Diseases,Tianjin Medical University Metabolic Diseases Hospital&Tianjin Institute of Endocrinology,Tianjin 300070,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2019年第10期653-657,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
国家自然科学基金项目(81603461、81700631、81774043)
天津市卫计委重点攻关项目(16KG167)
天津市教委自然科学基金一般项目(2016YD05)
天津医科大学朱宪彝纪念医院科研基金(2017DX05)。
