2型糖尿病患者甲状腺激素及抗体水平变化研究

Abnormal Changes of Serum Thyroid Hormones and Antibodies in Type 2 Diabetic Patients

背景近年来,临床上发现2型糖尿病患者甲状腺激素的改变和抗体升高的现象多于非糖尿病人群,而真正危害2型糖尿病患者身心健康的正是其多种并发症及合并症,考虑到甲状腺疾病对人体的危害同样重大,由此引发了对2型糖尿病患者甲状腺激素和抗体改变的思考。目的探讨2型糖尿病患者甲状腺激素及抗体水平的变化情况。方法选取2018年4月-2019年3月中国医科大学附属第一医院全科医学科收治的172例2型糖尿病患者作为2型糖尿病组,同时选取160例非糖尿病患者作为对照组。收集患者性别、年龄、糖尿病病程、糖化血红蛋白(HbA1c)水平、高血压病史、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)等指标,并测定甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平。再根据糖尿病病程,将糖尿病患者分为病程<1年组(19例)、1~10年组(69例)、>10年组(84例);根据HbA1c水平,将糖尿病患者分为HbA1c≤6.5%组(67例)、6.5%<HbA1c<9.0%组(84例)、HbA1c≥9.0%(21例);根据性别,将糖尿病患者分为男性组(90例)、女性组(82例);根据是否合并高血压,将糖尿病患者分为合并高血压组(110例)、未合并高血压组(62例),比较各组甲状腺激素及抗体的差异。结果2型糖尿病组TPOAb、TGAb水平高于对照组,FT3水平低于对照组(P<0.05)。不同病程糖尿病组TGAb、FT3水平比较,差异有统计学意义(P<0.05);其中>10年组TGAb水平高于<1年组,>10年组FT3水平低于1~10年组(P<0.05)。不同HbA1c水平糖尿病组TGAb水平比较,差异有统计学意义(P<0.05);其中6.5%<HbA1c<9.0%组TGAb水平高于HbA1c≤6.5%组(P<0.05)。男性TGAb、TSH水平低于女性(P<0.05)。合并高血压组FT4水平高于未合并高血压组(P<0.05)。Spearman秩相关分析结果显示,TGAb与年龄、糖尿病病程、HbA1c呈正相关(P<0.05);TSH与TG呈正相关(P<0.05);FT3与年龄、糖尿病病程呈负相关(P<0.05),与TC、HDL呈正相关(P<0.05)。结论2型糖尿病患者较非糖尿病人群更易合并甲状腺激素的改变和抗体的升高,而且与糖尿病病程、HbA1c、性别及是否合并高血压有关,所以2型糖尿病患者尤其是病程长、血糖控制不佳、合并高血压的女性患者更应注意甲状腺激素及抗体的筛查。

Background The prevalence of abnormal changes of thyroid hormones and elevated thyroid antibodies has been recently found to be higher in type 2 diabetics than that of non-type 2 diabetics.As thyroid disease-induced harm on physical health in the real world is similar to that of diabetes-related complications and comorbidities in type 2 diabetics,treating diabetes via improving abnormal changes of thyroid hormones and antibodies has become a concern issue.Objective To explore the abnormal changes of serum thyroid hormones and antibodies in type 2 diabetics.Methods 172 type 2 diabetics(type 2 diabetes group)were recruited from Department of General Medicine,the First Hospital of China Medical University from April 2018 to March 2019,and were compared to 160 non-type 2 diabetics(control group).Data were collected,including gender,age,duration of diabetes,HbA1c,history of hypertension,TC,TG,LDL,HDL,TPOAb,TGAb,TSH,FT3,and FT4.Thyroid hormones and antibodies were compared between diabetics and control groups,and were compared between the diabetics by duration of type 2 diabete〔s<1 yea(r n=19),1-10 year(s n=69),>10 year(s n=84)〕,HbA1〔c≤6.5%(n=67),6.5%<HbA1c<9.0%(n=84),≥9.0%(n=21)〕,gender〔men(n=90)and women(n=82)〕and prevalence of hypertension〔hypertension(n=110)and non-hypertension(n=62)〕.Results Type 2 diabetes group had higher average levels of TPOAb and TGAb and lower average level of FT3 than the control group(P<0.05).TGAb and FT3 differed significantly among diabetics by the duration of diabetes(P<0.05).In particular,those with over 10 years'duration of diabetes had higher average TGAb level than those had less than 1-year duration(P<0.05),and had lower average level of FT3 than those with 1-10-year duration(P<0.05).TGAb level differed significantly among diabetics by the HbA1c level(P<0.05).In particular,those with HbA1c greater than 6.5%but lower than 9.0%had higher average TGAb than those with HbA1c≤6.5%(P<0.05).The average TGAb and TSH levels of male diabetics were lower than those of female diabetics(P<0.05).The average FT4 level of hypertensive diabetics was higher than that of non-hypertensive diabetics(P<0.05).Spearman correlation analysis showed that TGAb was positively correlated with age,duration of diabetes,and HbA1c(P<0.05);TSH was positively correlated with TG(P<0.05);FT3 was negatively correlated with age and duration of diabetes(P<0.05),but was positively correlated with TC and HDL(P<0.05).Conclusion Type 2 diabetics are more likely to have thyroid hormone abnormalities and elevated thyroid antibodies,which may be associated with the duration of diabetes,HbA1c,gender,and hypertension.As a result,type 2 diabetics,especially women with long duration of diabetes,poor glycemic control,and hypertension should pay more attention to the screening of thyroid hormones and antibodies.