Correlation Between Thyroid Stimulating Hormone Level And Urinary ACR In Elderly Patients With T2DM

Objective:The purpose of this study was to see if there was a link between Thyroid Stimulating Hormone（TSH）and Urinary microalbumin/creatinine（ACR）in elderly type 2 diabetic patients with normal thyroid function,Further,whether TSH affects the occurrence and progression of Diabetic Kidney Disease（DKD）.Methods:Retrospectively collected 266 elderly patients with T2DM who were hospitalized in the Department of Endocrinology of the Affiliated Hospital of Yan’an University and the Department of General Medicine of the Cardiov ascular and Cerebrovascular Branch of the Affiliated Hospital of Yan’an Univer sity were collected from July 2020 to November 2021.The general data of the included patients included:age,gender,height（cm）,weight（Kg）,systolic blo od pressure SBP（mm Hg）,diastolic blood pressure DBP（mm Hg）,duration of T2DM,and complications such as Diabetic Peripheral Neuropathy（DPN）a nd Diabetic Retinopathy（DR）.Laboratory indicators include:blood glucose ass essment:fasting blood glucose（FBG）,glycosylated hemoglobin（Hb A1C）;Neph ropathy-related indicators:Urinary microalbumin/creatinine（ACR）,blood creatini ne（Scr）,blood uric acid（UA）,urea nitrogen（BUN）,cystatin C（Cys-C）,retin ol binding protein（RBP）,β2-microglobulin（β2-MG）;Lipid-related indicators:tri glycerides（TG）,total cholesterol（TC）,high-density lipoprotein cholesterol（HD L-C）,low-density lipoprotein cholesterol（LDL-C）;Thyroid function-related indic ators:free triiodothyronine（FT₃）,free thyroxine（FT₄）,thyroid stimulating horm one（TSH）.The subjects included in the study were grouped according to AC R level and TSH level.SPSS25.0 was used to analyze the differences between the indicators at different levels of ACR,to explore whether there was a corre lation between TSH and ACR levels in elderly patients with normal thyroid fu nction,and to select binary and multivariate Logistic regression analysis to exp lore the risk factors for DKD in elderly patients with T2DM.Draw ROC curv e to explore the predictive value of TSH for DKD in elderly T2DM patients.Results:1.The 266 elderly T2DM patients with normal thyroid function were included and grouped according to ACR levels.There were significant differences（P<0.05）among the three groups in the comparison of general data:duration of T2DM,BMI,systolic blood pressure,diastolic blood pressure,and the composition of diabetic retinopathy prevalence and diabetic peripheral neuropathy prevalence;In the comparison of laboratory indexes,There were significant differences in Hb A1c,Scr,Cys-C,UA,β2-MG,e GFR,RBP among the three groups（P<0.05）.There was significant difference in TSH level among the three groups（P<0.05）.2.The 266 elderly patients with T2DM who were included were grouped according to TSH by tertile and compared the differences in laboratory indicators between the three groups.The results showed that as TSH levels increased,the levels of TC,LDL-C,ACR,andβ2-MG increased as well,with statistical differences（P<0.05）.With an increase in TSH levels,FT₄ showed a negative trend,with significant differences（P=0.002）.3.Spearman’s analysis of the correlation between TSH levels and laboratory parameters in elderly patients with T2DM showed that there were significant positive correlations between TSH levels andβ2-MG,TC,LDL-C and ACR（P<0.05）.The correlation coefficients were 0.294,0.304,0.255 and 0.432,respectively,and there was a significant negative correlation between TSH and FT₄（P>0.05）with a correlation coefficient of-0.175.4.The dependent variable Y in elderly T2DM patients was DKD,and univariate binary Logistic regression analysis was utilized.The results showed that BMI,duration of T2DM,diastolic blood pressure,systolic blood pressure,combined peripheral neuropathy,combined retinopathy,TSH,FT₃,Scr,BUN,Cys-C,β2-MG,RBP,UA and e GFR were all influential factors for the development of DKD in elderly T2DM patients.Eliminate the influence of confounding factors by multivariate logistic regression analysis.The results showed that TSH was an influential factor in the development of DKD in elderly patients with T2DM（OR:1.664,95%CI:1.261 to 2.194,p<0.001）.Other influencing factors included the duration of T2DM disease（OR:1.065,95%CI:1.016 to 1.115,P=0.009）,and combined diabetic retinopathy status（OR:3.150,95%CI:1.541 to 6.439,P=0.002）.5.The results of the drawing ROC curve show that the TSH level has predictive value for the occurrence of DKD in elderly patients with T2DM（AUC=0.650,95%CI:0.584-0.716,P-value<0.001）,and when the critical value of TSH is 3.42umol/L,the sensitivity of TSH to predict the occurrence of DKD is 37.7%,and the specificity is86.8%.Conclusion:1.Elderly patients with normal thyroid functioning T2DM have TSH levels that are positively correlated with ACR.As TSH rises,the ACR shows an upward trend.2.In senior patients with T2DM,TSH levels,the course of diabetes,and diabetic retinopathy are all risk factors for DKD.3.TSH levels were found to have a strong relationship withβ2-MG,TC,LDL-C,and FT₄.