糖尿病合并桥本甲状腺炎患者临床特征及甲状腺自身免疫对胰岛功能的影响

Clinical characteristics of patients with diabetes mellitus combined with hashimoto thyroiditis and effects of thyroid autoimmunity on islet function

目的探讨2型糖尿病合并桥本甲状腺炎患者的临床特征以及甲状腺自身免疫状态对2型糖尿病胰岛功能的影响。方法采用回顾性病例对照研究,选取2015年8月～2016年12月于首都医科大学附属北京潞河医院内分泌科住院的2型糖尿病患者758例,收集性别、年龄等一般资料及甲功、生化、胰岛功能等相关指标。根据桥本甲状腺炎相关抗体A-TPO、A-TG水平将患者分为2型糖尿病合并桥本甲状腺炎组和单纯2型糖尿病组,比较两组间临床特点差异。进一步将患者分为C肽水平低组及C肽水平高组,通过单因素分析找出可能影响C肽水平的因素,并通过多因素Logistic回归分析验证桥本甲状腺炎为胰岛功能差的独立危险因素。结果 2型糖尿病合并桥本甲状腺炎组227例,单纯2型糖尿病组531例。与单纯2型糖尿病组比较,2型糖尿病合并桥本甲状腺炎组舒张压升高,腰臀比降低,C肽2 h水平降低,血肌酐降低,差异有统计学意义(P <0.05);C肽0 h和尿酸水平降低,女性比例升高,差异有高度统计学意义(P <0.01)。单因素分析显示:年龄、糖尿病病程、体重指数、腰围、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、肌酐、尿酸、三酰甘油、低密度脂蛋白胆固醇(HDL-C)、冠心病、桥本甲状腺炎均为影响C肽水平的混杂因素(P <0.05)。多因素Logistic回归分析结果显示:桥本甲状腺炎是2型糖尿病患者胰岛功能差的独立危险因素(OR=1.887,95%CI:1.256～2.835,P=0.002),同时糖尿病病程、HbA1c、FPG、HDL-C也是其独立危险因素。结论 2型糖尿病合并桥本甲状腺炎相比于单纯2型糖尿病患者胰岛功能差,且桥本甲状腺炎是2型糖尿病患者胰岛功能差的独立危险因素。

Objective To investigate the clinical features of patients with type 2 diabetes mellitus (T2DM) combined with hashimoto thyroiditis and the effects of thyroid autoimmune status on islet function in T2DM. Methods A retrospective case-control study was conducted on 758 patients with type 2 diabetes admitted to the Department of Endocrinology, Beijing Luhe Hospital Affiliated to Capital Medical University from August 2015 to December 2016. General data such as gender and age, as well as related indicators such as thyroid function, biochemistry and islet function, were collected. Patients were divided into type 2 diabetes mellitus combined with hashimoto thyroiditis group and type 2 diabetes mellitus group according to the levels of antibody A-TPO, A-TG associated with hashimoto thyroiditis, and the differences in clinical characteristics between the two groups were compared. The patients were further divided into the group with low C-peptide level and the group with high C-peptide level. Univariate analysis was performed to identify the factors that might affect the C-peptide level, and multivariate Logistic regression analysis was performed to verify that hashimoto thyroiditis was an independent risk factor for islet dysfunction. Results There were 227 patients with type 2 diabetes mellitus combined with hashimoto thyroiditis and 531 patients with type 2 diabetes mellitus only. Compared with the simple type 2 diabetes group, the diastolic blood pressure increased, the waist-hip ratio decreased, the level of C-peptide 2 h decreased, and the serum creatinine decreased in the type 2 diabetes mellitus combined with hashimoto thyroiditis group, and the difference was statistically significant (P < 0.05). C peptide 0 h and uric acid levels decreased, and the proportion of women increased, the difference was highly statistically significant (P < 0.01). Univariate analysis showed that age, diabetes course, body mass index, waist circumference, glycosylated hemoglobin (HbA1c), fasting blood glucose (FPG), creatinine, uric acid, triglyceride, low-density lipoprotein cholesterol (HDL-C), coronary heart disease, and hashibon thyroiditis were confactors affecting C-peptide level (P < 0.05). Multivariate Logistic regression analysis showed that hashimoto thyroiditis was an independent risk factor for islet dysfunction in type 2 diabetes patients (OR = 1.887, 95%CI, 1.256-2.835, P = 0.002), and the course of diabetes, HbA1c, FPG and HDL-C were also independent risk factors. Conclusion Compared with patients with type 2 diabetes mellitus combined with hashimoto thyroiditis, patients with type 2 diabetes mellitus have poor islet function, and hashimoto thyroiditis is an independent risk factor for poor islet function in patients with type 2 diabetes mellitus.