亚临床甲状腺功能减退症对2型糖尿病患者的代谢影响

Metabolic effects of subclinical hypothyroidism in patients with type 2 diabetes mellitus

目的探讨2型糖尿病合并亚临床甲状腺功能减退症(SCH)患者的临床特征以及亚临床甲状腺功能减退对患者机体代谢及胰岛功能的影响。方法选取2018年9月~2020年6月于潍坊市人民医院内分泌科住院的2型糖尿病683例,除外临床、亚临床甲状腺疾病后剩余613例,按系统抽样方法选取其中150例作为甲状腺功能正常组,明确诊断为SCH的62例作为观察组,比较2组间各生化指标和胰岛功能的差异。结果亚临床甲减组患者与甲状腺功能正常组相比,女性多于男性,年龄较大,差异有统计学意义(P<0.05)。亚临床甲减组在身高、游离甲状腺素(FT4)水平明显低于甲状腺功能正常组,差异具有统计学意义(P<0.05)。亚临床甲减组在甲状腺球蛋白(TG-Ab)、甲状腺髓过氧化物酶(TPO-Ab)显著高于甲状腺功能正常组,差异具有统计学意义(P<0.05)。亚临床甲减组患者血清三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平与甲功正常组比较,差异均无统计学意义(P>0.05)。亚临床甲减组患者空腹血糖(FBS)、糖化血红蛋白(HbA1C)与甲状腺功能正常组相比显著下降,差异具有统计学意义(P<0.05)。C肽释放试验显示亚临床甲减组基础C肽、口服葡萄糖后3h C肽明显高于甲状腺功能正常组,差异具有统计学意义(P<0.05)。相关分析发现FT4、HbA1c与TSH呈显著负相关,C肽释放试验C肽120min、180min水平与TSH呈正相关。结论T2DM合并亚临床甲减与甲状腺功能正常患者比较,血糖控制较好,胰岛功能水平高,但未发现血脂等代谢异常。

Objective To investigate the clinical features of type 2 diabetes mellitus with subclinical hypothyroidism(SCH)and the effect of subclinical hypothyroidism on the metabolism and islet function of patients.Methods Six hundred and eighty-three patients with type 2 diabetes who were hospitalized in the Endocrinology Department of Weifang People’s Hospital from September 2018 to June 2020,except for 613 cases after clinical and subclinical thyroid diseases,according to the systematic sampling method,150 cases were selected as normal thyroid function group,62 cases diagnosed as SCH as observation group,the differences of biochemical indexes and islet function between the two groups were compared.Results Compared with the normal thyroid function group,more women than men,older,difference was statistically significant(P<0.05).Among subclinical hypothyroidism group,the level of free thyroxine(FT4)was significantly lower than that of normal thyroid function group,difference was statistically significant(P<0.05).Thyroglobulin antibody(TGAB)and thyroid peroxidase antibody(TPOAB)in subclinical hypothyroidism group were significantly higher than those in normal thyroid function group,difference was statistically significant(P<0.05).Serum levels of triacylglycerol(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)in subclinical hypothyroidism were compared with those in normal hypothyroidism.All the differences were not statistically significant(P>0.05).The fasting blood glucose(FBS),glycosylated hemoglobin(HbA1 C)in subclinical hypothyroidism group decreased significantly compared with the normal thyroid function group,difference was statistically significant(P<0.05).C peptide release test showed that the basic C peptide of subclinical hypothyroidism group and 3 h C peptide after oral glucose were significantly higher than those of normal thyroid function group,difference was statistically significant(P<0.05).The correlation analysis found that the FT4,HbA1 c was significantly negatively correlated with TSH,and the C peptide release test showed a positive correlation with the peptide level of 30 minutes and 180 minutes.Conclusion T2 DM compared with patients with subclinical hypothyroidism and normal thyroid function,blood glucose control is better and islet function level is high,but no metabolic abnormalities such as blood lipids are found.