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老年2型糖尿病患者非甲状腺疾病综合征血清学特征及与慢性肾脏病的关系 预览 被引量:6

Serological characteristics of nonthyroidal illness syndrome and its correlation with chronic kidney disease in elderly patients with type 2 diabetes
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摘要 目的 通过分析住院老年2型糖尿病(T2DM)患者非甲状腺疾病综合征(NTIS)与慢性肾脏病(CKD)的相关性,探讨NTIS在防治老年T2DM中的价值.方法 根据甲状腺功能测定,将2012年10月至2014年9月在我院住院的126例老年T2DM患者分为NTIS组30例及非NTIS(NNTIS)组96例,检测并比较其血肌酐(SCr)、尿白蛋白排泄率(ACR)等临床指标.根据估算的肾小球滤过率(eGFR)及ACR诊断CKD,eGFR< 60ml/(min·1.73m2)被定义为肾功能不全.结果 (1) 126例患者中NTIS的发生率为23.81% (30/126).(2) 126例患者肾功能不全的患病率为57.94%(73/126).NTIS组患者[76.67%(23/30)]肾功不全的患病率较NNTIS组患者[52.08%(50/96)]高(P=0.017).(3) NIST组患者较NNITS组患者年龄较高(P<0.001),TT3 (P=0.001)、TT4(P=0.005)、FT3(P<0.001)、FT4(P=0.036)、TSH(P=0.012)、ALB (P<0.001)、TC (P=0.027)、TG(P=0.034)、LDL(P=0.032)、eGFR(P=0.004)及Ca(P< 0.001)水平较低.(4)Spearman单因素相关分析显示,NTIS与ACR(P=0.011)、年龄(P< 0.001)、肾功能不全(P=0.001)正相关,与ALB(P<0.001)、Ca(P<0.001)负相关.(5)多因素logistic回归分析发现ALB(OR=0.246,P=0.006)及肾功能不全(OR=5.346,P=0.004)是影响NTIS发生的独立因素.结论 住院老年T2DM患者NTIS可能提示其CKD已达到3期以上,并可能是病情严重及预后不良的预测因子. Objective To investigate the relationship ofnonthyroidal illness syndrome (NTIS) and chronic kidney disease (CKD) in the elderly hospitalized patients with type 2 diabetes (T2DM) and to assess the value of NTIS in T2DM prevention and treatment. Methods According to the thyroid function tests, 126 elderly patients hospitalized during October 2012 to September 2014 in our hospital were divided into NTIS group (n = 30) and non-NTIS (NNTIS) group (n = 96). The clinical data such as serum creatinine, urine albumin creatinine ratio (ACR) of the 2 groups were detected and compared. According to the modification of diet in renal disease (MDRD) equation, the diagnosis of renal insufficiency was established when estimated glomerular filtration rate (eGFR) 〈 60ml/(min ·1.73m2). Results (1) The incidence of NTIS in the 126 patients was 23.81% (30/126). (2) The incidence of renal insufficiency in the cohort was 57.94% (73/126). The incidence of renal insufficiency in NTIS group [76.67%(23/30)] was significantly higher than in NNTIS group [52.08% (50/96); P = 0.017]. (3) The patients in NTIS group were older than those in NNTIS group (P 〈 0.001). The level of total triiodothyronine (TT3; P = 0.001), total thyroxine (TT4; P = 0.005), free triiodothyronine (FT3; P〈 0.001), free thyroxine (FT4; P= 0.036), thyroid-stimulating hormone (TSH; P= 0.012), albumin (ALB; P〈 0.001), total cholesterol (TC; P = 0.027), triglycerides (TG; P = 0.034), low-density lipoprotein cholesterol (LDL-C; P = 0.032), eGFR(P = 0.004) and calcium (Ca; P〈 0.001) were lower in NTIS group than in NNTIS group. (4) The Spearman univariate correlation analysis showed that NTIS was positively correlated with ACR (P=0.011), age (P〈 0.001) and renal insufficiency (P=0.001), and wasnegatively correlated with ALB (P 〈 0.001) and Ca (P 〈 0.001). (5) The multivariate logistic regression analysis showed that AL
作者 向茜 马琼麟 黄静 曾维 XIANG Qian , MA Qiong-Lin, HUANG Jing, ZENG Wei (1Department of Endocrinology, 2Department of Nuclear Medicine, the Fifth Affiliated Hospital of Kunming Medical University/Diannan Central Hospital of Honghe State, Gejiu 661000, China)
出处 《中华老年多器官疾病杂志》 2015年第5期352-357,共6页 Chinrse journal of Multiple Organ Diseases in the Elderly
关键词 糖尿病性肾病 非甲状腺疾病综合征 老年人 糖尿病 2型 肾疾病 肾功能不全 diabetic nephropathies nonthyroidal illness syndrome aged diabetes mellitus, type 2 kidney disease renalinsufficiency
作者简介 向茜,E—mail:qian921004@sina.com
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