2型糖尿病患者发生肾功能异常与其甲状腺功能的关系研究
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摘要
目的探讨2型糖尿病患者肾损伤的发生与甲状腺功能异常发生的关联。方法回顾性分析2016年8月至2017年9月贵州医科大学附属医院内分泌科691例2型糖尿病住院患者性别、年龄、家族史、体重指数(BMI)、病程、并发症、血糖、糖化血红蛋白(HbA1c)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、尿素氮(BUN)、血肌酐(Scr)、胱抑素C(Cys C)和尿微量白蛋白(m Alb),根据其甲状腺功能检查结果分为2型糖尿病伴甲状腺功能正常组(正常组)与2型糖尿病伴甲状腺功能异常组(异常组),后者包括甲状腺功能亢进(简称甲亢)、亚临床甲亢、甲状腺功能减低(简称甲减)、亚临床甲减和低T_3。比较两组患者肾脏功能异常情况及其与性别、年龄、家族史、BMI、病程、HbA1c和并发症的关联,并采用二分类Logistic回归分析2型糖尿病患者肾脏功能异常的相关危险因素。结果 (1)异常组BUN(Z=2.945,P=0.003)、Scr(Z=2.685,P=0.007)、Cys C(Z=4.498,P=0.000)、m Alb(Z=6.073,P=0.000)和TSH(Z=8.139,P=0.000)均高于正常组,FT_3(Z=6.297,P=0.000)和FT_4(Z=4.981,P=0.000)低于正常组(P<0.05);(2)2型糖尿病患者中甲状腺功能异常发生率为25.04%,以亚甲减发生率最高,但对肾功能损伤以低T_3明显,且各类型甲状腺甲功异常m Alb水平均升高(P<0.05);(3)异常组中肾脏功能异常发生率75.7%(131/173)高于正常组46.1%(239/518),差异有统计学意义(χ2=45.63,P=0.000),在性别、家族史、年龄、BMI、病程≤20年、血糖、HbA1c≤13%、无并发症和伴一个并发症中,异常组肾脏功能异常发生率均高于正常组(P<0.05);(4)二分类Logistic回归分析,性别(OR=1.463)、年龄(OR=2.171)、病程(OR=1.804)、并发症(OR=5.863)、血糖(OR=1.753)和甲状腺功能异常(OR=3.535)是2型糖尿病患者肾脏功能异常的相关危险因素(P<0.05)。结论 2型糖尿病患者肾脏功能损害的发生与甲状腺功能异常有关,高龄、病程长、并发症多、甲状腺功能异常和血糖高的男性是2型糖尿病患者肾脏功能损伤的危险因素,临床上对2型糖尿病合并甲状腺功能异常患者应定期监测肾脏功能,重点采取积极的干预保护措施,以延缓糖尿病肾脏损害的发生和进一步发展。
Objective To investigate the relationship between renal dysfunction of type 2 diabetes patients and thyroid dysfunction. Methods In this study we retrospectively analyzed from 691 type 2 diabetes patients in guizhou medical university affiliated hospital endocrinology, the data was selected from August 2016 to September 2017. We collected the information of all patients included gender, age, family history, body mass index(BMI), the course of disease, complications, blood glucose, glycosylated hemoglobin(Hb A1 c), thyroid stimulating hormone(TSH), Free triiodothyronine(FT_3), Free thyroxine(FT_4), blood urea nitrogen(BUN), serum creatinine(Scr), cystatin C(Cys C) and Urinary albumin(m Alb). According to its thyroid function test results, type 2 diabetes is divided into type 2 diabetes mellitus with normal thyroid function group(normal group) and type 2 diabetes mellitus with thyroid dysfunction group(abnormal group) the latter includes hyperthyroidism,subclinical hyperthyroidism,hypothyroidism,subclinical hypothyroidism and low T_3. and we also compared the difference between renal dysfunction and T2 DM with thyroid dysfunction in two groups patients. Furthermore, we used classification Logistic regression analysis to find the relevant influencing factors of type 2 diabetes patients renal dysfunction. Results(1) The laboratory test results level of normal group is higher than abnormal group, which is include BUN(Z=2.945 P=0.003), Scr(Z=2.685 P=0.007), Cys C(Z=4.498 P=0.000), m Alb(Z=6.073 P=0.000) and TSH(Z=8.139 P=0.000),butFT_3(Z=6.297 P =0.000) and FT_4(Z=4.981 P =0.000) level is reduced(P <0.05);(2)The incidence of thyroid dysfunction in type 2 diabetes mellitus is 25.04%, the incidence of subclinical hypothyroidism is the highest, but low T_3 on renal function impairment is the most obvious, and the level of m Alb is increased in various types of thyroid dysfunction.(3) The incidence of abnormal group's renal dysfunction is 75.7%(131/173),which is higher than the incidence of normal group 46.1%(239/518), the difference is considered statistically significant(χ2=45.63 P=0.000).The incidence of abnormal group's renal dysfunction is higher than normal group with this following factors gender, family history, age, BMI, the course of disease≤20 year, blood glucose, Hb A1 c≤13%, no complications and with a complications(P<0.05);(4) Classification Logistic regression analysis showed that gender(OR=1.463), age(OR=2.171), the course of disease(OR=1.804), complications(OR=5.863), blood glucose(OR=1.753) and thyroid dysfunction(OR=3.535) are relevant influencing factors of typeⅡdiabetes patients renal dysfunction(P<0.05). Conclusion TypeⅡdiabetes patients renal dysfunction is related to thyroid dysfunction, advanced age, long duration, much complications, thyroid dysfunction and poor blood glucose control of male, which are the risk factors of kidney damage of typeⅡdiabetes patients. TypeⅡdiabetes mellitus with normal thyroid function should regularly monitor kidney,and take active intervention protection measures to delay the kidney damage's occurrence and further development.
Objective To investigate the relationship between renal dysfunction of type 2 diabetes patients and thyroid dysfunction. Methods In this study we retrospectively analyzed from 691 type 2 diabetes patients in guizhou medical university affiliated hospital endocrinology, the data was selected from August 2016 to September 2017. We collected the information of all patients included gender, age, family history, body mass index(BMI), the course of disease, complications, blood glucose, glycosylated hemoglobin(Hb A1 c), thyroid stimulating hormone(TSH), Free triiodothyronine(FT_3), Free thyroxine(FT_4), blood urea nitrogen(BUN), serum creatinine(Scr), cystatin C(Cys C) and Urinary albumin(m Alb). According to its thyroid function test results, type 2 diabetes is divided into type 2 diabetes mellitus with normal thyroid function group(normal group) and type 2 diabetes mellitus with thyroid dysfunction group(abnormal group) the latter includes hyperthyroidism,subclinical hyperthyroidism,hypothyroidism,subclinical hypothyroidism and low T_3. and we also compared the difference between renal dysfunction and T2 DM with thyroid dysfunction in two groups patients. Furthermore, we used classification Logistic regression analysis to find the relevant influencing factors of type 2 diabetes patients renal dysfunction. Results(1) The laboratory test results level of normal group is higher than abnormal group, which is include BUN(Z=2.945 P=0.003), Scr(Z=2.685 P=0.007), Cys C(Z=4.498 P=0.000), m Alb(Z=6.073 P=0.000) and TSH(Z=8.139 P=0.000),butFT_3(Z=6.297 P =0.000) and FT_4(Z=4.981 P =0.000) level is reduced(P <0.05);(2)The incidence of thyroid dysfunction in type 2 diabetes mellitus is 25.04%, the incidence of subclinical hypothyroidism is the highest, but low T_3 on renal function impairment is the most obvious, and the level of m Alb is increased in various types of thyroid dysfunction.(3) The incidence of abnormal group's renal dysfunction is 75.7%(131/173),which is higher than the incidence of normal group 46.1%(239/518), the difference is considered statistically significant(χ2=45.63 P=0.000).The incidence of abnormal group's renal dysfunction is higher than normal group with this following factors gender, family history, age, BMI, the course of disease≤20 year, blood glucose, Hb A1 c≤13%, no complications and with a complications(P<0.05);(4) Classification Logistic regression analysis showed that gender(OR=1.463), age(OR=2.171), the course of disease(OR=1.804), complications(OR=5.863), blood glucose(OR=1.753) and thyroid dysfunction(OR=3.535) are relevant influencing factors of typeⅡdiabetes patients renal dysfunction(P<0.05). Conclusion TypeⅡdiabetes patients renal dysfunction is related to thyroid dysfunction, advanced age, long duration, much complications, thyroid dysfunction and poor blood glucose control of male, which are the risk factors of kidney damage of typeⅡdiabetes patients. TypeⅡdiabetes mellitus with normal thyroid function should regularly monitor kidney,and take active intervention protection measures to delay the kidney damage's occurrence and further development.
引文
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[3]胡进,季一勤,何绍明,等.糖尿病患者围术期主要心血管不良事件预防研究进展[J].临床军医杂志,2018,46(2):231-234.
[4]Economic costs of diabetes in the U.S.in 2012[J].Diabetes Care,2013,36(4):1033-1046.
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[6]王雪,王云枝.糖尿病肾病发生及发展的相关因素[J].中国临床实用医学,2017,8(5):99-101.
[7]Sakly W,Manka?A,Achour A,et al.Thyroid-related autoantibodies in Tunisian patients with type 1 diabetes[J].Endocr Res,2012,37(2):59-66.
[8]Joffe BI,Distiller LA.Diabetes mellitus and hypothyroidism:Strange bedfellows or mutual companions[J].World J Diabetes,2014,5(6):901-904.
[9]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42.
[10]中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南—甲状腺疾病的实验室及辅助检查[J].中华内科杂志,2007,46(8):697-702.
[11]府伟灵,徐克前.临床生物化学检验[M].北京:人民卫生出版社,2012:1-463.
[12]胡晓东,黄泽平.左旋甲状腺素治疗不同促甲状腺激素浓度老年亚临床甲状腺功能减退患者临床观察[J].临床军医杂志,2017,45(5):525-527.
[13]李桂凤,张素英,蒲健.左旋甲状腺素对妊娠期甲状腺功能减退患者血清叶酸、甲状腺激素水平及妊娠结局的影响[J].中国临床实用医学,2017,6:55-57.
[14]许晓燕,李肃宁.2型糖尿病合并甲状腺疾病的临床分析[J].宁夏医学杂志,2016,38(9):795-797.
[15]Mansournia N,Riyahi S,Tofang chiha S,et al.Sub clinical hypothyroidism and diabetic nephropathy in Iranian patients with type2 diabetes[J].J Endocrinol Invest,2017,40(3):289-295.
[16]Fur ukawa S,Yamamoto S,Todo Y,et al.A ssociation between subclinical hypothyroidism and diabetic nephropathy in patients with type 2 diabetes mellitus[J].Endocr J,2014,61(10):1011-1018.
[17]Zhou JB,Li HB,Zhu XR,et al.Subclinical hypothyroidism and the risk of chronic kidney disease in T2D subjects:A case-control and doseresponse analysis[J].Medicine(Baltimore),2017,96(15):e6519.
[18]Meuwese CL,Gussekloo J,de Craen AJ,et al.Thyroid status and renal function in older persons in the general population[J].J Clin Endocrinol Metab,2014,99(8):2689-2696.
[19]Asvold BO,Bj?ro T,Vatten LJ.Association of thyroid function with estimated glomerular filtration rate in a population-based study:the HUNT study[J].Eur J Endocrinol,2011,164(1):101-105.
[20]Gopinath B,Harris DC,Wall JR,et al.Relationship between thyroid dysfunction and chronic kidney disease in community-dwelling older adults[J].Maturitas,2013,75(2):159-164.
[21]Ye Y,Gai X,Xie H,et al.Impact of thyroid function on serum cystatin C and estimated glomerular filtration rate:a cross-sectional study[J].Endocr Pract,2013,19(3):397-403.
[22]Mariani LH,Berns JS.The renal manifestations of thyroid disease[J].J Am Soc Nephrol,2012,23(1):22-26.
[23]彭静.甲状腺功能与2型糖尿病眼底病变及肾脏病变的相关性分析[D].吉林大学,2017.
[24]Basu G,Mohapatra A.Interactions between thyroid disorders and kidney disease[J].Indian Journal of Endocrinology and Metabolism,2012,16(2):204.
[25]van Hoek I,Daminet S.Interactions between thyroid and kidney function in pathological conditions of these organ systems:a review[J].Gen Comp Endocrinol,2009,160(3):205-215..
[26]Tziomalos K,Athyros VG.Diabetic Nephropathy:New Risk Factors and Improvements in Diagnosis[J].Rev Diabet Stud,2015,12(1-2):110-118.
[27]Al-Rubeaan K,Youssef AM,Subhani SN,et al.Diabetic nephropathy and its risk factors in a society with a type 2 diabetes epidemic:a Saudi National Diabetes Registry-based study[J].PLo S ONE,2014,9(2):e88956.
[28]刘东伟,潘少康,刘章锁.糖尿病肾病的临床危险因素[J].中国实用内科杂志,2017,37(3):189-191.
[29]陈小瑜,杨艾,李婷,等.2型糖尿病患者并发肾脏疾病影响因素的Meta分析[J].中国全科医学,2015,18(22):2732-2736.
[30]官涛,郑科,刘军辉,等.ROBO4/ARF6信号通路在糖尿病肾病患者肾小球组织的表达及意义[J].解放军医学杂志2016,41(4):267-272.
[31]刁宗礼,郭维康,刘文虎.内质网应激在糖尿病肾病发病机制中的研究进展[J].兰州大学学报(医学版)2016,42(2):76-80.
[2]Ginter E,Simko V.Type 2 diabetes mellitus,pandemic in 21st century[J].Adv Exp Med Biol,2012,771:42-50.
[3]胡进,季一勤,何绍明,等.糖尿病患者围术期主要心血管不良事件预防研究进展[J].临床军医杂志,2018,46(2):231-234.
[4]Economic costs of diabetes in the U.S.in 2012[J].Diabetes Care,2013,36(4):1033-1046.
[5]Vondra K,Vrbikova J,Dvorakova K.Thyroid gland diseases in adult patients with diabetes mellitus[J].Minerva Endocrinol,2005,30(4):217-236.
[6]王雪,王云枝.糖尿病肾病发生及发展的相关因素[J].中国临床实用医学,2017,8(5):99-101.
[7]Sakly W,Manka?A,Achour A,et al.Thyroid-related autoantibodies in Tunisian patients with type 1 diabetes[J].Endocr Res,2012,37(2):59-66.
[8]Joffe BI,Distiller LA.Diabetes mellitus and hypothyroidism:Strange bedfellows or mutual companions[J].World J Diabetes,2014,5(6):901-904.
[9]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42.
[10]中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南—甲状腺疾病的实验室及辅助检查[J].中华内科杂志,2007,46(8):697-702.
[11]府伟灵,徐克前.临床生物化学检验[M].北京:人民卫生出版社,2012:1-463.
[12]胡晓东,黄泽平.左旋甲状腺素治疗不同促甲状腺激素浓度老年亚临床甲状腺功能减退患者临床观察[J].临床军医杂志,2017,45(5):525-527.
[13]李桂凤,张素英,蒲健.左旋甲状腺素对妊娠期甲状腺功能减退患者血清叶酸、甲状腺激素水平及妊娠结局的影响[J].中国临床实用医学,2017,6:55-57.
[14]许晓燕,李肃宁.2型糖尿病合并甲状腺疾病的临床分析[J].宁夏医学杂志,2016,38(9):795-797.
[15]Mansournia N,Riyahi S,Tofang chiha S,et al.Sub clinical hypothyroidism and diabetic nephropathy in Iranian patients with type2 diabetes[J].J Endocrinol Invest,2017,40(3):289-295.
[16]Fur ukawa S,Yamamoto S,Todo Y,et al.A ssociation between subclinical hypothyroidism and diabetic nephropathy in patients with type 2 diabetes mellitus[J].Endocr J,2014,61(10):1011-1018.
[17]Zhou JB,Li HB,Zhu XR,et al.Subclinical hypothyroidism and the risk of chronic kidney disease in T2D subjects:A case-control and doseresponse analysis[J].Medicine(Baltimore),2017,96(15):e6519.
[18]Meuwese CL,Gussekloo J,de Craen AJ,et al.Thyroid status and renal function in older persons in the general population[J].J Clin Endocrinol Metab,2014,99(8):2689-2696.
[19]Asvold BO,Bj?ro T,Vatten LJ.Association of thyroid function with estimated glomerular filtration rate in a population-based study:the HUNT study[J].Eur J Endocrinol,2011,164(1):101-105.
[20]Gopinath B,Harris DC,Wall JR,et al.Relationship between thyroid dysfunction and chronic kidney disease in community-dwelling older adults[J].Maturitas,2013,75(2):159-164.
[21]Ye Y,Gai X,Xie H,et al.Impact of thyroid function on serum cystatin C and estimated glomerular filtration rate:a cross-sectional study[J].Endocr Pract,2013,19(3):397-403.
[22]Mariani LH,Berns JS.The renal manifestations of thyroid disease[J].J Am Soc Nephrol,2012,23(1):22-26.
[23]彭静.甲状腺功能与2型糖尿病眼底病变及肾脏病变的相关性分析[D].吉林大学,2017.
[24]Basu G,Mohapatra A.Interactions between thyroid disorders and kidney disease[J].Indian Journal of Endocrinology and Metabolism,2012,16(2):204.
[25]van Hoek I,Daminet S.Interactions between thyroid and kidney function in pathological conditions of these organ systems:a review[J].Gen Comp Endocrinol,2009,160(3):205-215..
[26]Tziomalos K,Athyros VG.Diabetic Nephropathy:New Risk Factors and Improvements in Diagnosis[J].Rev Diabet Stud,2015,12(1-2):110-118.
[27]Al-Rubeaan K,Youssef AM,Subhani SN,et al.Diabetic nephropathy and its risk factors in a society with a type 2 diabetes epidemic:a Saudi National Diabetes Registry-based study[J].PLo S ONE,2014,9(2):e88956.
[28]刘东伟,潘少康,刘章锁.糖尿病肾病的临床危险因素[J].中国实用内科杂志,2017,37(3):189-191.
[29]陈小瑜,杨艾,李婷,等.2型糖尿病患者并发肾脏疾病影响因素的Meta分析[J].中国全科医学,2015,18(22):2732-2736.
[30]官涛,郑科,刘军辉,等.ROBO4/ARF6信号通路在糖尿病肾病患者肾小球组织的表达及意义[J].解放军医学杂志2016,41(4):267-272.
[31]刁宗礼,郭维康,刘文虎.内质网应激在糖尿病肾病发病机制中的研究进展[J].兰州大学学报(医学版)2016,42(2):76-80.