降糖药物对甲状腺功能正常的2型糖尿病患者甲状腺结节患病情况的影响

Frequency of thyroid nodules detected in euthyroid type 2 diabetic patients treated with different hypoglycemic agents

目的调查采用不同降糖药物治疗的甲状腺功能正常的2型糖尿病患者甲状腺结节的患病情况并进行相关因素分析。方法收集甲状腺功能正常、服用降糖药物≥1年且降糖方案未改变的2型糖尿病患者220例,根据降糖方案分6组,A组单独二甲双胍治疗,B组单独促胰岛素分泌剂治疗,C组单纯胰岛素治疗,D组二甲双胍+胰岛素治疗,E组胰岛素+促胰岛素分泌剂、二甲双胍之外的其他降糖口服药治疗,F组:其他降糖口服药联合或单独(多数是阿卡波糖)治疗,分析各组甲状腺结节的患病情况及影响因素。结果 220例患者有72.3%存在甲状腺结节。甲状腺结节检测情况随糖尿病病程(OR=1.078,95%CI:1.023-1.137,P=0.005)增长、年龄(OR=1.031,95%CI:1.004-1.058,P=0.022)增大而增加。A组甲状腺结节检出率最低,与A组(63.9%)相比,C组(80.0%)和D组(84.4%)结节检出率明显增高(P<0.05)。以A组为参照组,经性别、年龄、BMI、TSH、甘油三酯、HOMAIR、糖尿病病程、服药时间校正后,logistic回归分析发现其余5组均不影响甲状腺结节的发生风险(P>0.05)。结论住院2型糖尿病患者甲状腺结节患病情况较为普遍,糖尿病长病程及增龄均会增加甲状腺结节患病风险,高胰岛素血症可能是甲状腺结节发病促进因素。本次调查没有发现降糖药物与结节患病风险增加相关。

Objectives To investigate if the use of anti-diabetic drugs affect the presence of thyroid nodules in euthyroid patients with type 2 diabetes mellitus （T2DM）.Methods Two hundred and twenty patients with T2DM hospitalized for poor glycemic control were enrolled.All patients wer treated by different hypoglycemic agents with unchanged regime for more than one year.Patients were subgrouped into six groups according to their hypoglycemic modalities：group A, patients who used only metformin;group B, only insulinotropic agents;group C, only insulin;group D, insulin with metformin;group E, insulin with other oral antidiabetic agents; and group F, other oral antidiabetic agents in combination or only （ mostly acarbose） .The presence of thyroid nodules in each group were summarized.Results The frequency of thyroid nodules in this study group of patients with type 2 diabetes mellitus was found to be 72.3%,and there was trend toward a higher frequency in older patients（OR=1.031,95%CI：1.004-1.058,P=0.022） and with longer duration of diabetes （OR=1.078, 95%CI：1.023-1.137,P=0.005）.Group A had a lower incidence of thyroid nodules than with other anti -diabetic drugs.Compared with group A （63.9%）, the frequency of thyroid nodules in group C （80.0%）, and group D （84.4%）were higher （P〈0.05）.Using group A as a reference, logistic regression analysis was conducted to analyze hazard risk between thyroid nodules and different hypoglycemic modalities.The frequency of thyroid nodules was not different among the patient with different hypoglycemic modalities.Conclusion Thyroid nodule is common in hospitalized euthyroid patients with type 2 diabetes.Longer duration of diabetes, advanced age, higher level of insulin increased thyroid nodules frequen-cy.No association was found among different hypoglycemic agents with development of thyroid nodules.