2型糖尿病合并亚甲减对微血管并发症的影响

Influence of type 2 diabetic patients combined with subclinical hypothyroidism on diabetic microvascular complications

目的探讨亚临床甲状腺功能减退对2型糖尿病(T2DM)患者微血管并发症的影响。方法根据是否合并亚临床甲状腺功能减退将入组的280例T2DM患者分为单纯T2DM组(228例)和糖尿病合并亚临床甲减(SCH)组(52例),并且根据不同促甲状腺激素(TSH)水平将SCH组分为两组,即SCH1组(4.2≤TSH≤10μIU/ml,45例)和SCH2组(TSH≥10μIU/ml,7例),分析TSH水平与糖尿病肾病及视网膜病变的相关性。结果 SCH组总胆固醇、低密度脂蛋白、TSH水平高于DM组,SCH组DM肾病和视网膜病变的发生率显著高于DM组(P<0.05),且SCH2组DM肾病和视网膜病变的发生率高于SCH1组(P<0.05);Logistic回归分析结果显示亚临床甲状腺功能减退为T2DM患者糖尿病肾病及视网膜病变的危险因素。结论 T2DM合并亚临床甲减患者其糖尿病肾病及视网膜病变的发生率明显增高,且T2DM合并高水平TSH的患者发生糖尿病微血管并发症的风险更高,提示亚临床甲减是T2DM患者微血管病变独立的危险因素。

Objective To explore the influence of type 2 diabetic patients combined with subclinical hypothyroidism on diabetic microvascular complications（ diabetic nephropathy and diabetic retinopathy）. Methods 280 patients with type 2 diabetes were divided into subclinical hypothyroidism group（ SCH group,52 cases） and the euthyroid group（ DM group,228 cases）. Then the SCH group was divided into SCH1 group（4. 2≤TSH≤10 μIU/ml,45 cases） and SCH2 group（ TSH≥10 μIU/ml,7 cases）,according to the range of TSH levels. To explore the relationship between SCH and microvascular complications in type 2 diabetic patients. Results The total cholesterol,low density lipoprotein,TSH level in SCH group were significantly higher than that of DM group（ P〈0. 05）. The incidence of diabetic nephropathy and diabetic retinopathy in SCH group was significantly higher than that in DM group（P〈0. 05）,In addition,compared with SCH1 group,the incidences of diabetic nephropathy and diabetic retinopathy in SCH2 group was higher（ P〈0. 05）. Logistic regression analysis showed that subclinical hypothyroidism was a risk for diabetic nephropathy and diabetic retinopathy. Conclusion The incidence of diabetic nephropathy and diabetic retinopathy in type 2 diabetic patients combined with subclinical hypothyoidism is higher than that of the euthyroid patients. And the risk of microvascular complications in diabetic patients with high levels of TSH is further elevated. Subclinical hypothyoidism could be a risk factor of diabetic nephropathy and diabetic retinopathy in type 2 diabetic patients.