2型糖尿病老年患者并发甲状腺结节的影响因素分析

Influencing Factors of Thyroid Nodules in Elderly Patients with Type 2 Diabetes Mellitus

【目的】探讨2型糖尿病(T2DM)老年患者并发甲状腺结节的影响因素。【方法】收集2015年6月至2017年6月在本院诊治的385例T2DM老年患者,按照有无结节分为甲状腺结节组(结节组,n=204)与无结节组(无结节组,n=181),检测两组患者血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1C)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)水平;采用Logistic回归分析影响T2DM患者并发甲状腺结节的危险因素;采用受试者工作特征曲线(ROC)分析各因素诊断发生甲状腺结节及结节超声高评分的效能;采用Pearson分析各因素之间的相关性。【结果】结节组患者年龄、病程、TC、TG、TSH、TPOAb水平显著高于无结节组患者,而HDL-C、FT3水平显著低于无结节组患者,其差异有统计学意义(P<0.05);多因素回归分析显示性别、年龄、TC、TSH及TPOAb是影响T2DM患者并发甲状腺结节的危险因素;多因素分析显示年龄>60岁、女性、结节发生在双侧且多发为术后复发的独立危险因素。【结论】TC>4.40 mmol/L;TPOAb>10.17×103IU/L;年龄>58.75岁;TSH>1.73 μIU/mL的老年T2DM患者需警惕甲状腺结节的发生,且高龄女性,结节多发在双侧的患者应密切关注,预防射频消融术后复发。

【Objective】 To explore the influencing factors of thyroid nodules in patients with type 2 diabetes mellitus (T2DM).【Methods】 A total of 385 patients with T2DM from June 2015 to June 2017 were selected as the research subjects , and were divided into thyroid nodules group (n=204) and non nodular group (n=181) according to whether they had thyroid nodules. General data of two groups of patients were collected. Serum triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (HbA1C), free triiodothyronine 3 (FT3), free thyroxine 4 (FT4) and thyrotropin (TSH), thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) level were detected. Logistic regression analysis was used to analyze the related factors of T2DM patients complicated with thyroid nodules and postoperative recurrence. Recieved operating characteristic curve (ROC) was used to analyze the effectiveness of various factors in diagnosing thyroid nodules and nodules with high ultrasound scores. The correlation between the factors was analyzed by Pearson.【Results】 The levels of age, course of disease, TC and TG in the nodule group were higher than those in the non-nodule group, while the levels of TSH, HDL-C, FT3 and TPOAb in the nodule group were lower than those in the non-nodule group (P<0.05). Multivariate regression analysis showed that gender, age, TC, TSH and TPOAb were risk factors for thyroid nodules in patients with T2DM. Multivariate analysis showed that age > 60 years old, female and nodules occurred bilaterally and multiple were independent risk factors for recurrence.【Conclusion】 Elderly patients with TC >4.40 mmol/L, TPOAb>10.17×103IU/L, age >58.75 years, TSH >1.73 μIU/mL should be alert to the occurrence of thyroid nodules, and elderly women with multiple nodules on both sides should pay close attention to prevent recurrence after radiofrequency ablation.