| Objective:The clinical significance of renal impairment in patients with type 2diabetes mellitus was investigated by comparing the changes of thyroid function and other parameters between the patients with type 2 diabetes mellitus and the patients with type 2 diabetic nephropathy?DN?.Methods:This study was a prospective observational study of 166 hospitalized patients with type 2 diabetes who were admitted to the department of emerge ncy medicine of Tianjin medical university general hospital from August 2017to August 2018.The data of patients general information?gender,age,smokin g history,history of drinking,BMI,waist circumference,presence of hypertensi on and diabetes duration,etc.?,thyroid function?free triiodothyronine?FT3?and free thyroxine?FT4?and thyroid stimulating hormone?TSH??,routine urine an d blood serum creatinine,uric acid and lipid and related indicators were collec ted.And through the kidney Diet improved test?Modification of Diet in takes diseases,MDRD?simplified formula estimated glomerular filtration rate?estim ated glomerular filtration rate,eGFR?.Patients were divided into DN group and non-DN group according to whether eGFR was decreased or not,and the diff erences of thyroid function and other indicators between the two groups were compared.Correlation analysis was used to compare FT3,FT4 and TSH conce ntrations with serum creatinine and eGFR concentrations.Patients in the DN g roup were successively divided into DN group?1?(60ml·min-1·1.73m-2?eGFR<90ml·min-1·1.73m-2),DN group?2?(30ml·min-1·1.73m-2?eGFR<60ml·mi n-1·1.73m-2)and DN group?3?(eGFR<30ml·min-1·1.73m-2)according to the stages of chronic kidn-ey disease.and the changes of thyroid function in pati ents with different eGFR in the three groups were compared.Result:A total of 166 patients with type 2 diabetes were included in this stud y,with an average age of 57.91±10.28 years.Among them,81?48.80%?patient s in the DN group were aged 60.81±9.02 years.There were 85 patients?51.20%?in the non-DN group,with an average age of 60.53±8.33 years.This stud-y included 82 cases?49.40%?of females and 84 cases?50.60%?of males.A mong them,28 cases?46.9%?were females in the DN group and 44 cases?51.8%?were females without DN group.The BMI of patients in the DN group was 26.73±1.47 kg/m2,while that of patients in the non-DN group was 26.31±3.03kg/m2.Obesity was defined as BMI>28,with 13 obese patients?16%?in the DN group and 16 obese patients?18.8%?in the non-DN group.The wa-ist circumference of patients in the DN group was 100.54±8.55cm,and that o f patients in the non-DN group was 97.95±9.59cm.In the DN group,there we-re 39 patients?48.1%?,36 patients?44.4%?and 54 patients?66.7%?with smo king history,drinking history and hypertension history,respectively,but in the non-DN group,there were 37 cases?43.5%?,35 cases?41.2%?and 48 cases?56.5%?,respectively.Diabetic course in the DN group was lower than that in the non-DN group?16 years vs 8 years?,p<0.001.The concentrations of G-HbA1c,lipid and uric acid in patients with DN group were higher than those without DN group,and the differences were statistically significant?p<0.001?.In the DN group,FT3?p<0.001?and FT4?p=0.027?concentrations were lo-w er,while TSH concentrations were higher?p=0.002?.There was a negative corr elation between FT3 and FT4 concentrations and serum creatinine concentrations?r=-0.373,p<0.001;r=-0.153,p=0.049?,and was positively correlated with eG FR?r=0.333,p<0.001 and r=0.154,p=0.047?.TSH was positively correlated w-ith serum creatinine?r=0.177,p=0.022?and negatively correlated with eGFR?r=-0.230,p=0.003?.There was a statistically significant difference in the conce-ntration of FT3 among groups 1,group 2 and group 3?p=0.002?.Conclusion:The concentration of FT3 and FT4 was lower in patients with DN than in patients without DN,while the concentration of TSH was higher.Wit-h the progressive aggravation of renal function impairment in DN patients,the concentration of FT3 showed a significant downward trend.This result can improve our understanding of the relationship between thyroid function and DN,suggesting that thyroid function can be used to evaluate the degree of renal damage in DN patients,so it is necessary to regularly monitor thyroid function in type 2 diabetes patients. |
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