李汉秋 冯奕习 陈见辉 叶永龙

[摘要]目的探討甲状腺功能与2型糖尿病肾病患者临床分期的关联性。方法本研究为回顾性病例对照研究设计，选取2021年1—2月在东莞市中医院内分泌科和体检科就诊的患者作为研究对象。从内分泌科选择25例单纯糖尿病患者（单纯糖尿病组）和50例糖尿病肾病患者（微量白蛋白尿组和大量白蛋白尿组，每组各25例）;从体检科选择与糖尿病患者的性别和年龄相匹配的25例健康志愿者作为对照组。测量研究对象的身高、体重，并收集研究对象的血肌酐、随机微量白蛋白、24 h 微量白蛋白、尿肌酐、胱抑素 C、促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、计算尿白蛋白肌酐比（UACR）、尿清蛋白排泄率（UAER）、估算的肾小球滤过率（eGFR）。结果与单纯糖尿病组相比，糖尿病肾病组 TSH 水平更高， FT3水平更低（均 P <0.05）。Spearman 相关分析显示在糖尿病肾病组， TSH 与血清肌酐、尿肌酐、胱抑素 C、UACR 和 UAER 呈正相关（均 P <0.05），与 eGFR 呈负相关（ P <0.001）; FT3和 FT4与血肌酐、UACR 和 eGFR 均呈正相关（均 P <0.05），差异有统计学意义。结论在糖尿病肾病组中可观察到高水平的 TSH 和低水平的 FT3。未来需要前瞻性研究来证实亚临床甲状腺功能减退症与糖尿病肾病之间的关联。

[关键词]糖尿病肾病;促甲状腺激素;病例对照研究;估算的肾小球滤过率

[中图分类号] R587  [文献标识码] A   [文章编号]2095-0616（2021）23-0151-05

A study of the correlation between thyroid function and clinical staging of the patients with type 2 diabetic nephropathy

LI  Hanqiu    FENG  Yixi    CHEN  Jianhui    YE  Yonglong

Department of Clinical Laboratory， Dongguan Traditional Chinese Medicine Hospital， Guangdong， Dongguan 523000， China

[Abstract] Objective To investigate the correlation between thyroid function and clinical staging of the patients with type II diabetic nephropathy （DN）. Methods This study was designed as a retrospective case-control study. The patients who were treated at Department of Endocrinology and Department of Health Checkup of Dongguan Traditional Chinese Medicine Hospital from January 2021 to February 2021 were selected as the subjects of research.25 patients with simple diabetes mellitus （the SDM group） and 50 patients with DN （the microalbumin uria group and the massive albuminuria group， each with 25 patients） were selected from Department of Endocrinology.25 healthy volunteers matched with the patients with DM in gender and age were selected from Department of Health Checkup as the control group. The height and weight of the subjects were measured， and their serum creatinine， random microalbumin， 24-h microalbumin， urine creatinine， cystatin C， thyroid stimulating hormone （TSH）， free triiodothyronine （FT3）， free thyroxine （FT4） were collected， and urine albumin-to- creatinine ratio （UACR）， urinary albumin excretion rate （UAER） and estimated glomerular filtration rate （eGFR） were calculated. Results Compared with the SDM group， the DN groups had higher TSH levels and lower FT3 levels （both， P <0.05）. Spearman correlation analysis showed that in the DN groups TSH was positively correlated with serum creatinine， urine creatinine， cystatin C， UACR and UAER （both， P <0.05） and negatively correlated with eGFR （P <0.001）; FT3 and FT4 were positively correlated with serum creatinine， UCAR and eGFR （both， P <0.05）， and the differences were statistically significant. Conclusion High level TSH and low level FT3 can be seen in the DN groups. In the future， prospective studies will be needed to confirm the correlation between subclinical hypothyroidism and DN.

[Key words] Diabetic nephropathy; Thyroid stimulating hormone; Case-control study; Estimated glomerular filtration rate

糖尿病肾病是终末期肾病的主要原因[1]。以前认为肾脏受累通常发生在糖尿病发病10年后，但最近的研究表明，早在糖尿病发病初期已观察到肾损伤，肾小管间质损伤在早期糖尿病肾病的发病机制中起重要作用[2]。甲状腺激素对于新陈代谢和能量稳态至关重要，并参与胰岛素作用和葡萄糖调节。早前的研究表明，糖尿病患者的甲状腺疾病患病率高于非糖尿病患者，且在2型糖尿病（type 2 diabetic mellitus，T2DM）患者中观察到明显的甲状腺功能减退症[3]，高水平促甲状腺激素（thyroid- stimulating hormone， TSH）和低水平的游离三碘甲状腺原氨酸（free triiodothyronine， FT3）与较高的慢性肾病风险有关[4]。……