亚临床甲状腺功能减退对2型糖尿病及其常见慢性并发症的影响

Influences of subclinical hypothyroidism on type 2 diabetes mellitus and its chronic complications

目的探讨亚临床甲状腺功能减退(亚临床甲减)对2型糖尿病(T2DM)及其常见慢性并发症的影响。方法将2018年1月至2019年12月北部战区总医院诊治的临床资料相对完整的321例T2DM患者按照其是否合并亚临床甲减分成单纯T2DM组(264例)和合并亚临床甲减组(57例),对患者的一般临床资料、生化指标及常见慢性并发症糖尿病视网膜病变、糖尿病肾脏疾病、糖尿病足病的发病情况进行回顾性分析。结果合并亚临床甲减组的总胆固醇、甘油三酯、尿白蛋白/肌酐比率、预估肾小球滤过率等明显高于单纯T2DM组,踝肱指数明显低于单纯T2DM组,高血压患病率明显高于T2DM组,糖尿病视网膜病变、糖尿病肾脏疾病、糖尿病足病的患病率高于单纯T2DM组,差异均有统计学意义(P<0.05,P<0.01)。经多因素非条件Logistic回归分析显示,高促甲状腺激素水平是糖尿病肾脏疾病(OR=1.087,95%CI:1.022~1.155)、糖尿病足(OR=1.071,95%CI:1.001~1.146)发生的独立危险因素,但不是糖尿病视网膜病变发生的独立危险因素。结论对新诊断的T2DM患者应尽早、并定期进行甲状腺功能检查,以便及早诊断是否合并亚临床甲减,从而减少或延缓糖尿病常见慢性并发症的发生、发展。

Objective To investigate the impacts of subclinical hypothyroidism(SCH)on type 2 diabetes mellitus(T2DM)and its common chronic complications.Methods A total of 321 T2DM patients with complete clinical data treated in Northern Theater General Hospital from January 2018 to December 2019 were divided into simple T2DM group(n=264)and T2DM with SCH group(n=57)according to whether they were complicated with subclinical hypothyroidism.The general clinical data,biochemical indexes and common chronic complications of diabetic retinopathy(DR),diabetic kidney disease(DKD)and diabetic foot disease(DFD)were retrospectively analyzed.Results The levels of total cholesterol,triglyceride,urinary albumin/creatinine ratio(UACR),estimated glomerular filtration rate(eGFR)and ankle brachial index(ABI)in T2DM with SCH group were significantly lower than those in alone T2DM group(all P<0.05),and the prevalence of hypertension,DR,DKD and DFD was significantly higher than that in alone T2DM group(P<0.05).Multivariate logistic regression analysis showed that high thyroid stimulating hormone level was the independent risk factor for DKD(OR=1.087,95%CI:1.022-1.155)and for DFD(OR=1.071,95%CI:1.001-1.146),but was not for diabetic retinopathy.Conclusion In newly diagnosed patients with type 2 diabetes,thyroid function test should be carried out as soon as possible and regularly so as to confirm subclinical hypothyroidism as soon as early in order to reduce the occurrence and development of common chronic complications of diabetes.