亚临床甲状腺功能减退与糖尿病慢性并发症相关性研究

Relationship between subclinical hypothyroidism and chronic complications of diabetes mellitus

目的探讨亚临床甲状腺功能减退（甲减）与2型糖尿病患者慢性并发症的相关性。方法将临床资料相对完整的1062例2型糖尿病患者按照是否合并亚临床甲减分为2型糖尿病合并亚临床甲减组（糖尿病＋甲减组）及2型糖尿病甲状腺功能正常组（糖尿病组），回顾性分析患者的一般资料，既往病史，合并糖尿病肾病、糖尿病视网膜病变、糖尿病周围神经病变、糖尿病外周血管病变、糖尿病足情况，辅助检查结果及实验室检查指标，并进行多因素非条件Logistic回归分析。结果糖尿病＋甲减组患者年龄、糖尿病病程、并存冠心病、代谢指标、超敏C反应蛋白、尿微量白蛋白排泄率及促甲状腺激素水平明显高于糖尿病组；糖尿病＋甲减组慢性并发症发病率较糖尿病组明显升高，分别为肾病62．8％对46．0％（P〈0．01），视网膜病变40．0％对28．7％（P〈O．05），周围神经病变33．8％对24．o％（P〈0．05），外周动脉病变50．7％对38．0％（P〈0．05），糖尿病足22．3％对12．3％（P〈O．01）；而踝臂指数、E峰／A峰值低于糖尿病组。经Logistic回归分析结果显示，高促甲状腺激素是糖尿病肾病（p-0．1273，OR-1．1361）、糖尿病足（19-0．1153，OR-1．1222）发生的独立危险因素。结论糖毒性可改变甲状腺自身免疫功能，亚临床甲减可促进糖尿病进程，是糖尿病肾病、糖尿病足发生的独立危险因素。老年2型糖尿病患者及病程较长者，应定期进行甲状腺功能检查，以便及早诊断和干预亚临床甲减，从而预防和延缓糖尿病慢性并发症的发生和发展。

Objective To explore the impacts of subclinical hypothyroidism （SCH） on chronic complications of type 2 diabetes mellitus. Methods Totally 448 patients with type 2 diabetes were divided into diabetes plus SCH group （n= 148） and control group （T2DM without SCH, n= 300）. The patient＇s general information, past medical history, chronic complications of diabetes including diabetic nephropathy （ DN ）, diabetic retinopathy （ DR）, diabetic peripheral neuropathy （ DPN）, peripheral arterial disease （PAD）, diabetic {oot（DF）, ancillary and laboratory test results were analyzed. Results The age, duration of diabetes, incidence of coronary heart disease and levels of fasting C-peptide, total cholesterol, triacylglyeerol, lipoprotein（a）, hs-CRP, LDL-C, UAER and thyroid stimulating hormone （TSH） [（6.8 ± 3.5） mIU/L vs. （2.1 ±1.3） mIU/L] anti- thyroidperoxidase antibody （TPO-Ab） [（253.6 ± 287.1） kU/L vs. （46.2 ± 80.7）] kU/L and thyroglobulin antibodies （TG-Ab） [（57.8±83.5）kU/L vs. （39.4±45.3）kU/L] were significantly higher, but the ankle brachial index（ABI） and E/A value were lower in diabetes plus SCH group than in control group （P〈0.01 or 0.05）. The prevalences of DN（ 630//00 vs. 46% , P〈0.01）, DR （40% vs. 29%o, P〈0.05）, DPN （34% vs. 24%0, P〈0.05）, PAD （51% vs. 38G , P〈0.05） and DF （22% vs. 12%, P〈0.01） were higher in diabetes plus SCH group than in control group. Logistic regression analysis demonstrated that high level of TSH was independent risk factor for DN （β= 0.1273, OR = 1.1361） and DF （β= 0.1153, OR = 1.1222） . Conclusions Subclinical hypothyroidism is an independent risk factor for diabetic nephropathy and diabetic foot, so the elderlywith longer duration of diabetes should regularly be checked in thyroid function to early find hypothyroidism.