Correlation Study Between Thyroid Hormone Levels And Diabetic Kidney Disease In Euthyroid Subjects With Type 2 Diabetes Mellitus

Objectives We studied the correlation of thyroid function with diabetic kidney disease in euthyroid subjects with type 2 diabetes mellitus(T2DM)to investigatethe influence of thyroid hormone levels in diabetic kidney disease.Methods A total of 241 T2DM patients hospitalized in Hebei General Hospital from November 2018 to June 2019 were retrospectively collected.The mean age of the subjects was 55.75 years,including 174 males and 67 females,176 T2DM patients with DKD were in the DKD group,and 65 newly diagnosed T2DM patients without complications were in the diabetes control group(DMcon group).Clinical data included age,height,weight,BMI,systolic blood pressure,diastolic blood pressure,serum creatinine,blood urea total cholesterol,triglycerides,high-density lipoprotein cholesterol,low density lipoprotein cholesterol,and apolipoprotein A1 apolipoprotein B,lipoprotein(a)promote thyroxine glycosylated hemoglobin(TSH)free T3,free T4,thyroid peroxidase antibody,glomerular filtration rate,UACR,microalbuminuria,total 24-hour urine trace albumin urine protein,urine protein,24-hour urinary protein.Results 1 The age and systolic blood pressure in DKD group were higher than those of the DMcon group,and the difference was statistically significant(P<0.01).There was no significant difference in BMI diastolic blood pressure,HDL cholesterol,apolipoprotein A1,lipoprotein a,Hb A1 c and other indicators between the two groups(P>0.05).2 Serum urea creatinine level in DKD group was significantly higher than that in DMcon group,with statistically significant difference(P<0.01).Serum total cholesterol,triglyceride,LDL cholesterol and apolipoprotein B level in DKD group were lower than those in DMcon group,with statistically significant difference(P<0.05).3 Serum FT3 level in the DKD group was lower than that in the DMcon group(4.40±0.69)vs(4.72±0.74)pmol/L,with statistically significant differences(P<0.01).Serum FT4 level of the DKD group was lower than that of the DMcon group(16.21±2.48)vs(17.15±2.79)pmol/L,and the difference was statistically significant(P=0.01).Serum TSH level of the DKD group was higher than that of the DMcon group(2.63 ± 1.46)vs(2.21 ±1.16)pmol/L,and the difference was statistically significant(P=0.04).4 According to the e GFR level,there are four levels of kidney damage,ranging from mild to severe.With gradual decrease of e GFR,the average level of FT3 and FT4 decreased gradually,with a statistically significant difference(P<0.01);while the TSH level increased gradually,with a statistically significant difference(P<0.01).Serum FT3 level in group G1 was higher than that in group G4(4.71±0.69)vs(4.15±0.64)pmol/L,with statistically significant difference(P<0.05).Serum FT4 level in G1 group was higher than that in G4 groups,(17.21 ± 2.58)vs(15.59 ± 2.57)pmol/L respectively,and the difference was statistically significant(P<0.05).Serum FT4 level in G1 group was higher than that in G3 groups,(17.21±2.58)vs(15.79±2.59)pmol/L respectively,and the difference was statistically significant(P<0.05).Serum TSH level of group G1 was lower than that of group G4,(2.14±1.39)vs(3.42±1.93)u IU/ml,with statistically significant difference(P<0.05).The TSH level of the G2 group was lower than that of the G4 group,(2.23±0.85)vs(3.42 ± 1.93)u IU/ml respectively,and the difference was statistically significant(P<0.05).5 DKD group was divided into 3 groups according to urinary albumin creatinine ratio(UCAR),U1 group UACR<30mg /g,U2 group UACR30-300mg/g,and U3 group UACR> 300mg/g.With UACR level gradually increased in DKD group,the average level of FT3 gradually decreased(P<0.01),with statistically significant difference.Serum FT4 level gradually decreased with the increase of UACR level,with(P=0.04),indicating a statistically significant difference.Serum TSH level increased with the increasing UACR level(P<0.01).FT3 level in group U1 was higher than that in group U2(4.69±0.68)vs(4.37±0.67)pmol/L,and the difference was statistically significant(P<0.05).The FT3 level of U1 group was higher than that of U3 group,respectively(4.69±0.68)vs(3.95±0.58)pmol/L,and the difference was statistically significant(P<0.05).The FT3 level of U2 group was higher than that of U3 group,respectively(4.37±0.67)vs(3.95±0.58)pmol/L,the difference was statistically significant(P<0.05).Serum TSH level of group U1 was lower than that of group U3,(2.10±1.27)vs(3.93±2.31)u IU/ml,and the difference was statistically significant(P<0.05).The TSH level in group U2 was lower than that in group U3,respectively(2.23±0.85)vs(3.42±1.93)u IU/ml,the difference was statistically significant(P<0.05).6 The glomerular filtration rate was listed as the dividing line at 60ml/min for logistic regression analysis.The regression analysis showed that systolic and diastolic blood pressure,serum FT3 and TSH were correlated with the decrease of glomerular filtration rate,with statistical difference(P<0.05).In addition,the urine protein creatinine ratio(UACR)of 30mg/g was set as the dividing line,and the influence of different indicators on UACR was analyzed by logistic regression analysis.It showed that age,systolic and diastolic blood pressure and serum TSH was correlated with the increase of UACR level,which was of statistical significance(P<0.05).Conclusions 1.In type 2 diabetic patients,even if the thyroid function is within the normal range,the serum FT3 and FT4 levels are closely related to the occurrence of diabetic nephropathy.2.Low levels of thyroxine and high levels of TSH are associated with the development of DKD.Figure1;Table6;Reference 194...