Thyroid hormones and diabetic nephropathy: An essential relationship to recognize
Thyroid hormones and diabetic nephropathy: An essential relationship to recognize
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甲状腺激素和糖尿病肾病：需要认识到的重要关系。
DOI：
10.1111/nep.13388
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发表时间：
2019-02-01
期刊：
影响因子：
2.5
通讯作者：
Liu, Fang
中科院分区：
文献类型：
--
作者：
Han, Qianqian;Zhang, Junlin;Liu, Fang
目的甲状腺激素代谢异常在2型糖尿病（T2 DM）和糖尿病肾病（DN）患者中普遍存在，但其与DN的关系尚不清楚，在临床实践中一直被忽视。本研究旨在探讨甲状腺激素与经活检证实的DN患者临床病理变化的关系。方法收集146例经肾活检证实的DN患者的临床及病理资料。将患者分为4组：甲状腺功能正常组、高促甲状腺激素（TSH）组、低游离三碘甲状腺原氨酸（FT 3）组（TSH、FT 4均正常）和高TSH+低FT 3组（FT 4均正常）。比较4组患者的临床病理特征。我们通过Logistic回归分析评估了甲状腺激素水平异常对DN的危险性，并对其他危险因素进行了多变量调整。我们还进行了四分位和八点分析TSH和FT 3水平，以确定其对DN的影响。结果正常组与高TSH组尿蛋白>5 g/24 h（P = 0.008）和肾小球病变程度（P = 0.011）差异有显著性。此外，估计肾小球滤过率（P =0.019），血清肌酐（P =0.014）和肾小球病变的严重程度（P =0.003）之间的甲状腺功能正常组和低FT 3组的水平显着差异。高TSH组、低FT 3组和高TSH+低FT 3组之间也有显著性差异。Logistic回归分析显示，高TSH、低FT 3与肾脏临床病理改变相关。四分法和八分法分析显示，TSH水平在4.54-5.67 mU/L的患者肾脏临床病理改变最严重，且肾脏改变的严重程度随FT 3水平的升高而降低。结论高TSH和（或）低FT 3的糖尿病肾病患者蛋白尿、肾功能不全及肾小球病变较重，提示调节甲状腺激素可能具有肾脏保护作用。
Aims Although abnormal thyroid hormone metabolism is common in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN), the relationship between thyroid hormones and DN is unclear and has been ignored during clinical practice. This study aimed to investigate the relationship between thyroid hormones and clinicopathologic changes in biopsy-proven DN patients. Methods Clinical and pathological data for 146 biopsy-proven DN patients were collected. The patients were divided into four groups: euthyroid group, high-thyroid stimulating hormone (TSH) group (SCH), low-free triiodothyronine (FT3) group (with normal levels of TSH and FT4), and high-TSH + low-FT3 group (with normal levels of FT4). The clinicopathologic features among the four groups were investigated. We evaluated the risks of abnormal thyroid hormone levels on DN by logistic regression with multivariable adjustments for other risk factors. We also performed quarterback and eight-point analyses of TSH and FT3 levels to determine their influences on DN. Results The overt proteinuria (>5 g/24 h) (P = 0.008) and severity of glomerular lesions (P = 0.011) differed between euthyroid group and high-TSH group significantly. Moreover, the levels of estimated glomerular filtration rate (P =0.019), serum creatinine (P =0.014), and severity of glomerular lesions (P =0.003) differed between the euthyroid group and low-FT3 group significantly. There were also significant differences between high-TSH, low-FT3 and high-TSH + low-FT3 patients, respectively. Respective correlations between high-TSH, low-FT3 and renal clinicopathologic changes were found to be significant according to logistic regression analyses. Quarterback and eight-point analyses indicated that patients with TSH levels of 4.54-5.67 mU/L had the most severe renal clinicopathologic changes, and the severity of renal changes decreased with increased FT3 levels. Conclusions Diabetic nephropathy patients with high-TSH and/or low-FT3 had more severe proteinuria, renal insufficiency, and glomerular lesions, suggesting that regulating thyroid hormones might have a renoprotective effect.