目的：观察2型糖尿病(type 2 diabetes mellitus，T2DM)肾病患者甲状腺自身抗体及甲状腺功能的变化情况。方法：从2014年8月至2014年12月本院收治的2型糖尿病患者中选择病例按照糖尿病肾病分期分为三组：中量尿蛋白组[(moderate urinary protein，MUP)，40例，尿蛋白含量>300 mg/24 h的Ⅲ期以上糖尿病肾病]、微量尿蛋白组[(trace urinary protein，TUP)，40例，尿蛋白含量30~300 mg/24 h的Ⅲ期糖尿病肾病]、对照组[(control，CK)，40例，糖尿病未合并肾病]。分别比较三组对象常规游离三碘甲腺原氨酸(free triiodothyronine，FT3)游离甲状腺素(free thyroxin，FT4)、促甲状腺激素(thyroid stimulating hormone，TSH)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)与甲状腺过氧化物酶抗体(thyroid peroxidase antibody，TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody，TgAb)和促甲状腺激素受体抗体(thyrotrophin receptor antibody，TRAb)指标的差异。结果：MUP组和TUP组的血清T3，T4浓度水平略高于CK组，FT3浓度水平略低于CK组，但各项指标差异均无统计学意义(P>0.05)。TUP组和MUP组的血清FT4浓度水平与CK组数值的差异具有统计学意义(P<0.05)。MUP组、TUP组和CK组的TSH浓度水平差异无统计意义(P>0.05)。MUP组的TPOAb、TgAb和TRAb阳性率在3组患者中均最高，其次为TUP组，3种甲状腺自身抗体阳性率最低值均出现在CK组，而且3组患者的3种甲状腺自身抗体指标差异均具有统计学意义(P<0.05)。结论：对2型糖尿病肾病患者进行甲状腺自身抗体的筛查及甲状腺功能评估有重要意义。
Clinical analysis of thyroid autoantibody and function of type 2 diabetic nephropathy patients
Objective: To explore the clinical applicability of thyroid autoantibody on type 2 diabetic nephropathy patients. Methods: This study was carried out 120 diabetic nephropathy patients receiving clinical treatment during August 2014 to December 2014. The patients were divided into three groups, namely moderate urinary protein (MUP, 40 patients with urine protein >300 mg/24 h, diabetic nephropathy above phase III), trace urinary protein (TUP 40 patients with urine protein 30~300 mg/24 h, diabetic nephropathy phase III) and the control group (CK, 40 diabetes patients without nephropathy). The conventional thyroid hormone indexes and thyroid autoantibody indexes among the three groups were compared. Results: The (free triiodothyronine, FT3) levels of MUP, TUP and CK were (4.01±1.63), (4.09±1.35) and (4.34±1.78) pmol/L, respectively, but the differences were not statistically significant (P>0.05). The (free thyroxin, FT4) levels of CK, TUP and MUP were (17.48±1.68), (16.69±1.14) and (16.53±2.07) pmol/L respectively, and the differences between CK and both observation groups were statistically different (P<0.05). The (thyroid stimulating hormone, TSH) levels of MUP, TUP and CK were (2.29±0.99), (2.22±1.18) and (2.15±0.79) mU/L respectively, but the differences were not statistically significant (P>0.05). The greatest positive rates of thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and thyrotrophin receptor antibody (TRAb) were observed in MUP, followed by TUP, while the lowest positive rates were observed in CK. The differences of positive rates of TPOAb, TgAb and TRAb among the three groups were statistically significant (P<0.05). Conclusion: The conventional thyroid hormone indexes are not accurate enough to detect the changes in thyroid function. The thyroid autoantibody indexes are of significant applicability for the prediction of autoimmune thyroid disease on type 2 diabetic nephropathy patients.