中老年2型糖尿病患者血清甲状腺激素水平变化及临床意义

Change of Serum Thyroid Hormones in Middle-age or Elderly Patients with Type 2 Diabetes Mellitus and Its Clinical Significance

【目的】探讨中老年2型糖尿病（T2DM ）患者血清甲状腺激素水平、甲状腺自身抗体变化的临床意义。【方法】选取中老年T2DM 患者190例（T2DM组）及同期体检的中老年健康人群180例（对照组）。检测两组对象糖化血红蛋白（HbA1c）、空腹血糖（FPG）、高敏C反应蛋白（hs-CRP）、促甲状腺素（TSH）、三碘甲状腺原氨酸（T3）、甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）及抗甲状腺过氧化物酶抗体（aTPOAB）、抗甲状腺球蛋白抗体（aTGAB）水平。计算受试者的稳态模型胰岛素抵抗指数（HOMA-IR）及体质量指数（BMI）。同时T2DM 组行甲状腺彩色超声检查。【结果】T2DM 组患者 HbA1c、FPG、hs-CRP、BMI及 HOMA-IR均显著高于对照组，差异有统计学意义（ P ＜0．01）。T2DM 组受试者超声检查提示性别差异无统计学意义（ P ＞0．05）。中老年T2DM组甲状腺疾病的总患病率（31．6％）高于对照组（18．3％）（ P＜0．05）。T2DM组中女性患者抗体（aTPOAB、aTGAB）阳性率显著高于男性患者抗体阳性率（ P ＜0．05）。【结论】中老年T2DM患者甲状腺功能及甲状腺自身抗体已有改变，其具有较高的甲状腺疾病患病率。定期检测中老年T2DM 患者甲状腺功能及抗体并做甲状腺超声检查有重要的临床意义。

[Objective] To explore the clinical significance of the change of serum thyroid hormone and thyroid autoantibody in middle age or elderly patients with type 2 diabetes mellitus（T2DM ） and its clinical sig-nificance .[Methods] Totally 190 middle-age and elderly patients with T2DM （T2DM group） and 180 middle-age and elderly healthy people（control group） were chosen .The levels of glycosylated hemoglobin （HbA1c） , fasting blood sugar（FPG） ,high sensitivity C-reactive protein（hs-CRP） ,thyrotrophin（TSH） ,triiodothyronine （T3） ,thyroxine（T4） ,free trioodothyronine（FT3） ,free thyroxine（FT4） ,anti-thyroid peroxidase antibody （aTPOAB） and antithyroglobulin antibody（aTGAB） in two groups were determined .The homeostasis model assessment-insulin resistance index （HOMA-IR） and body mass index （BMI） in subjects were calculated . Meanwhile thyroid color ultrosonography was performed in T 2DM group .[Results] HbA1c ,FPG ,hs-CRP , BMI and HOMA-IR in T2DM group were markedly higher than those in control group ,and there was signifi-cant difference（ P〈0 .01） .Ultrasonography of subjects in T2DM group showed that there was no significant difference in sex（ P 〉0 .05） .The prevalence of thyroid dysfunction in middle-age and elderly T2DM group （31 .6% ） was higher than that in control group（18 .3% ）（ P〈0 .05） .The positive rate of antibodies（aTPOAB and aTGAB） in female patients of T2DM group was significantly higher than that in male patients （ P〈0 .05） .[Conclusion] The middle-age and elderly patients with T2DM have the changes of thyroid function and thyroid autoantibodies and high prevalence of thyroid disease .The regular detection of thyroid function ,antibodies and thyroid ultrasonography for middle-age and elderly patients with T2DM has important clinical significance .