亚临床甲状腺功能减退症对2型糖尿病视网膜病变的影响

Influence of subclinical hypothyroidism on type 2 diabetic retinopathy

目的分析2型糖尿病患者临床资料,探讨亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)对2型糖尿病患者发生糖尿病视网膜病变(diabetic retinopathy,DR)的影响。方法412例2型糖尿病患者,其中54例合并SCH者为合并SCH组,358例未合并SCH者为未合并SCH组,比较2组血清游离三碘甲状腺原氨酸(free triiodthyronine,FT_(3))、游离甲状腺素(free thyroxine,FT_(3))、促甲状腺激素(thyroid stimulating hormone,TSH)水平及DR比率等临床资料。412例患者根据是否发生DR分为DR组105例和未发生DR组307例,比较2组血清FT_(3)、FT_(4)、TSH水平及SCH比率等临床资料;采用多因素logistic回归分析2型糖尿病患者发生DR的影响因素。结果合并SCH组女性比率(64.8%)、DR比率(37.0%)及血清总胆固醇[(5.63±1.13)mmol/L]、三酰甘油[(2.70±1.97)mmol/L、TSH(8.04±3.73)u/L]水平均高于未合并SCH组[44.7%、23.7%、(5.28±1.14)mmol/L、(2.19±1.64)mmol/L、(2.12±1.16)u/L](P<0.05),血清高密度脂蛋白胆固醇[(1.12±0.38)mmol/L]、FT_(3)[(3.82±0.62)pmol/L]、FT_(3)[(13.93±2.43)pmol/L]水平均低于未合并SCH组[(1.25±0.36)mmol/L、(4.09±0.90)pmol/L、(16.17±3.76)pmol/L](P<0.05);2组年龄、糖尿病病程、体质量指数、收缩压、舒张压及空腹血糖、糖化血红蛋白、低密度脂蛋白胆固醇水平比较差异均无统计学意义(P>0.05)。DR组SCH比率(19.0%)、收缩压[(139.83±21.39)mm Hg]及血清总胆固醇[(5.93±1.25)mmol/L]、三酰甘油[(2.56±1.79)mmol/L]、TSH[(4.00±3.60)u/L]水平均高于未发生DR组[11.1%、(134.80±21.55)mm Hg、(5.12±1.03)mmol/L、(2.16±1.65)mmol/L、(2.52±1.90)u/L](P<0.05),糖尿病病程[(12.27±5.34)年]长于未发生DR组[(10.36±4.65)年](P<0.05),血清高密度脂蛋白胆固醇水平[(1.14±0.43)mmol/L]低于未发生DR组[(1.26±0.33)mmol/L](P<0.05);2组女性比例、年龄、体质量指数、舒张压及空腹血糖、糖化血红蛋白、低密度脂蛋白胆固醇、FT_(3)、FT_(3)水平比较差异均无统计学意义(P>0.05)。糖尿病病程(OR=1.074,95%CI:1.023~1.127,P=0.004)、血清总胆固醇(OR=1.771,95%CI:1.399~2.242,P<0.001)、高密度脂蛋白胆固醇(OR=0.394,95%CI:0.188~0.828,P=0.014)、TSH(OR=1.186,95%CI:1.070~1.313,P=0.001)、SCH(OR=1.406,95%CI:1.120~1.765,P=0.002)水平是2型糖尿病患者发生DR的影响因素。结论2型糖尿病女性患者易合并SCH,合并SCH者易发生DR,糖尿病病程、总胆固醇、高密度脂蛋白胆固醇、TSH、SCH是2型糖尿病患者发生DR的影响因素。

Objective To observe the clinical data of patients with type 2 diabetic mellitus(T2 DM)and to investigate the influence of subclinical hypothyroidism(SCH)on diabetic retinopathy(DR)in patients with T2 DM.Methods Totally 412 patients with T2 DM were divided into 54 patients complicated with SCH(SCH group)and 358 patients complicated with no SCH(no-SCH group).The levels of serum free triiodthyronine(FT_(3)),free thyroxine(FT_(3))and thyroid stimulating hormone(TSH),and the occurrence of DR were compared between two groups.And 412 T2 DM patients were divided into 105 patients with DR(DR group)and 307 patients without DR(no-DR group),and the levels of serum FT_(3),FT_(4)and TSH were compared between two groups.Multivariate logistic regression analysis was used to study the influencing factors of DR in patients with T2 DM.Results The percentages of female patients and DR as well as the levels of total cholesterol,triacylglycerol and TSH were higher in SCH group[64.8%,37.0%,(5.63±1.13)mmol/L,(2.70±1.97)mmol/L,(8.04±3.73)u/L]than those in no-SCH group[44.7%,23.7%,(5.28±1.14)mmol/L,(2.19±1.64)mmol/L,(2.12±1.16)u/L](P<0.05),the levels of high-density lipoprotein cholesterol(HDL-C),FT3 and FT4 were lower in SCH group[(1.12±0.38)mmol/L,(3.82±0.62)pmol/L,(13.93±2.43)pmol/L]than those in no-SCH group[(1.25±0.36)mmol/L,(4.09±0.90)pmol/L,(16.17±3.76)pmol/L](P<0.05),and there were no significant differences in the age,course of disease,body mass index,systolic blood pressure,diastolic blood pressure,fasting plasma glucose,glycated hemoglobin and low-density lipoprotein cholesterol between two groups(P>0.05).The duration of diabetes was longer,and the SCH rate,systolic blood pressure,total cholesterol level,triacylglycerol and TSH were higher in DR group[(12.27±5.34)years,19.0%,(139.83±21.39)mm Hg,(5.93±1.25)mmol/L,(2.56±1.79)mmol/L,(4.00±3.60)u/L]than those in no-DR group[(10.36±4.65)years,11.0%,(134.80±21.55)mm Hg,(5.12±1.03)mmol/L,(2.16±1.65)mmol/L,(2.52±1.90)u/L],the level of HDL-C was lower in DR group[(1.14±0.43)mmol/L]than that in no-DR group[(1.26±0.33)mmol/L](P<0.05),and there were no significant differences in the age,percentage of female patients,body mass index,diastolic blood pressure,fasting plasma glucose,glycated hemoglobin,low-density lipoprotein cholesterol,FT3 and FT4 between two groups(P>0.05).The course of disease(OR=1.074,95%CI:1.023-1.127,P=0.004),total cholesterol(OR=1.771,95%CI:1.399-2.242,P=0.000),TSH(OR=1.186,95%CI:1.070-1.313,P=0.001),HLD-C(OR=0.394,95%CI:0.188-0.828,P=0.014)and SCH(OR=1.406,95%CI:1.120-1.765,P=0.002)were the influencing factors of DR in patients with T2 DM.Conclusions SCH usually occurs in female patients with T2 DM,and DR usually occurs in T2 DM patients with complication of SCH.The duration of diabetes,total cholesterol,HDL-C,TSH and SCH are the influencing factors of DR in patients with T2 DM.