甲状腺功能正常的2型糖尿病合并桥本甲状腺炎患者甲状腺抗体水平与早期肾脏损伤相关性的研究  

The relationship between thyroid antibody level and early renal injury in patients with type 2 diabetes mellitus and Hashimoto’s thyroiditis with normal thyroid function

作　　者：付瑞瑞 陈晶晶 方瑶 陆雨纯 周晓燕 应长江 FU Ruirui;CHEN Jingjing;FANG Yao(The First Clinical Medical College of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学第一临床医学院,221000 [2]徐州医科大学遗传学教研室 [3]徐州医科大学附属医院内分泌科

出　　处：《中国糖尿病杂志》2024年第9期657-661,共5页Chinese Journal of Diabetes

基　　金：国家自然科学基金(82271205);江苏省中医药科技计划项目(MS2022141)。

摘　　要：目的 探讨T2DM合并桥本甲状腺炎(HT)患者甲状腺抗体水平与早期肾脏损伤的相关性。方法 选取2018年1月至2022年12月于徐州医科大学附属医院内分泌科住院治疗的T2DM患者375例,根据是否合并HT分为单纯T2DM组(n=191)和T2DM合并HT组(HT,n=184),选取同期197名体检健康者为正常对照(NC)组。HT组根据UACR水平分为微量白蛋白尿亚组(MUAlb,30≤UACR≤300 mg/g,n=70)和正常白蛋白尿亚组(NUAlb,UACR<30 mg/g,n=114);另根据甲状腺抗体是否阳性分为甲状腺球蛋白抗体阳性[TGAb(+)]亚组(n=40)、甲状腺过氧化物酶抗体阳性[TPOAb(+)]亚组(n=56)及TGAb和TPOAb双抗体阳性[TGAb(+)+TPOAb(+)]亚组(n=88)。比较各组一般资料及生化指标的差异。结果 与NC组比较,HT、T2DM组吸烟史、饮酒史、尿肌酐、α1微球蛋白、UACR、FPG、HbA_(1)c、LDL-C、TC及TG升高(P<0.05),HDL-C降低(P<0.05)。与NUAlb亚组比较,MUAlb亚组年龄、DM病程、FPG、HbA_(1)c、TGAb、TPOAb、促甲状腺激素(TSH)升高(P<0.05),游离三碘甲状腺原氨酸(FT3)、e GFR降低(P<0.05)。Spearman相关分析显示,UACR与年龄、HbA_(1)c、TPOAb、TGAb、TSH呈正相关(P<0.01),与FT3呈负相关(P<0.01)。TGAb(+)+TPOAb(+)亚组UACR高于TGAb(+)、TPOAb(+)亚组(P<0.05)。Logistic回归分析显示,TSH、TGAb、TPOAb、HbA_(1)c是MUAlb的危险因素,FT3是MUAlb的保护因素。结论 甲状腺功能正常的T2DM合并HT患者TPOAb、TGAb与早期肾脏损伤密切相关。Objective To explore the correlation between thyroid antibody levels and early renal injury in patients with type 2 diabetes mellitus(T2DM)combined with Hashimoto’s thyroiditis(HT).Methods A total of 375 T2DM patients hospitalized in The Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2022 were selectedas the study subjects,and 197 healthy people were selected as the control subjects.The patients with T2DM were divided into simple T2DM group(n=191)and T2DM combined with HT group(HT,n=184).According to the urinary albumin/creatinine ratio(UACR)level,T2DM patients with HT were divided into microalbuminuria subgroup(MUAlb,30≤UACR≤300 mg/g,n=70)and normal albuminuria subgroup(NUAlb,UACR<30 mg/g,n=114).According to whether the thyroid antibody was positive,they were divided into thyroid peroxides antibody[TPOAb(+)]subgroup(n=56),thyroglobulin antibody[TGAb(+)]subgroup(n=40)and TGAb and TPOAb double antibody positive subgroup(n=88).Results Compared with the NC group,the smoking,drinking,urinary creatinine,alpha 1‐microglobulin,UACR,FPG,HbA_(1)c,LDL‐C,TC,and TG in the HT and T2DM groups increased(P<0.05),while HDL‐C decreased(P<0.05).Compared with the NUAlb subgroup,the MUAlb subgroup showed age,DM duration,FPG,HbA_(1)c,TGAb,TPOAb,thyroid stimulating hormone(TSH)increased(P<0.05),while FT3 and eGFR decreased(P<0.05).Spearman correlation analysis showed that UACR was positively correlated with age,HbA_(1)c,TPOAb,TGAb,TSH(P<0.01),and negatively correlated with FT3(P<0.01).The UACR of the TGAb(+)+TPOAb(+)subgroup was higher than that of the TGAb(+)and TPOAb(+)subgroups(P<0.05).Logistic regression analysis showed that TSH,TGAb,TPOAb,and HbA_(1)c were risk factors for MUAlb,while FT3 was a protective factor for MUAlb.Conclusions In T2DM with HT patients with normal thyroid function,TPOAb and TGAb are closely related to the occurrence of early renal injury.

关 键 词：糖尿病 2型 桥本甲状腺炎 甲状腺抗体 尿白蛋白/肌酐比值 

分 类 号：R587.1[医药卫生—内分泌] R581.4[医药卫生—内科学]