α-硫辛酸联合左甲状腺素治疗亚临床甲状腺功能减退合并糖尿病视网膜病变效果观察

Effect of α-lipoic acid combined with levothyroxine in the treatment of subclinical hypothyroidism complicated with diabetic retinopathy

目的探讨α-硫辛酸联合左甲状腺素对亚临床甲状腺功能减退合并糖尿病视网膜病变患者血清视黄醇结合蛋白4(RBP4)及糖脂代谢的影响。方法采用前瞻性队列分析的方法,按照国家诊断标准,对2018年1月—2020年12月在临沂市河东区人民医院收治住院的389例亚临床甲状腺功能减退(SCH)合并糖尿病视网膜病变(DR)患者中,110例符合重症亚临床甲状腺功能减退合并糖尿病视网膜病变诊断标准的患者随机分为试验组56例和对照组54例。观察对象均按照糖尿病常规治疗,包括行为干预、临床常规降糖、调脂、降压、抗凝聚、改善循环,所有患者均给予左甲状腺素口服,实验组增加α-硫辛酸治疗600 mg/d,加入250 ml 0.9%NaCl溶液静滴,连用8周。观察治疗前后患者的RBP4、Cys-C、Hcy、hs-CRP、血糖(FPG、2 h PG、HbA_(1c))、血脂(TG、TC、LDL-C、FFA)、β细胞功能(HOMA-IR、HOMA-β)等变化,同步监测药物不良反应。结果入组病例治疗后观察指标RBP4、Cys-C、Hcy、hs-CRP水平对比治疗前均出现均下降(P<0.05),但实验组下降幅度更大(P<0.01);2组FPG、2 h PG、HbA_(1c)、HOMA-IR、TG、TC、LDL-C、FFA均下降,HOMA-β均升高,但实验组变化更明显(P<0.01);入组病例治疗过程中均未发现明显不良反应。结论α-硫辛酸联合左甲状腺素治疗亚临床甲状腺功能减退合并糖尿病视网膜病变患者,可明显降低患者RBP4和血糖、血脂水平,改善胰岛β细胞功能。

Objective To investigate the effects ofα-lipoic acid combined with levothyroxine on serum retinol binding protein4(RBP4)and glucose and lipid metabolism in patients with subclinical hypothyroidism complicated with diabetic retinopathy.Methods A prospective cohort analysis was performed in 389 patients with subclinical hypothyroidism(SCH)combined with diabetic retinopathy(DR)admitted to People's Hospital of Hedong District from January 2018 to December 2020 according to national diagnostic criteria.A total of 110 patients who met the diagnostic criteria of severe subclinical hypothyroidism complicated with diabetic retinopathy were randomly divided into experimental group(n=56)and control group(n=54).The observation subjects were treated according to routine diabetes treatment,including behavioral intervention,routine clinical hypoglycemic,lipid-regulating,hypotensive,anti-coagulation,and circulation improvement.Meanwhile,all patients were given oral levothyroxine.In the experimental group,αiabetes tcid was added to 600 mg/d,and 250 ml 0.9%NaCl solution was added to intravenous drip for 8 weeks.The changes of RBP4,Cys-C,Hcy,hs-CRP,blood glucose(FPG,2 h PG,HbA_(1c)),blood lipid(TG,TC,LDL-C,FFA),0.9%NaCl solution was added to intravenous dripects before and after treatment were observed,and adverse drug reactions were monitored simultaneously.Results After treatment,the levels of RBP4,Cys-C,Hcy and hs-CRP were all decreased compared with before treatment(P<0.05),but the decrease was more significant in the experimental group(P<0.01).FPG,2 h PG,HbA_(1c),HOMA-IR,TG,TC,LDL-C and FFA were decreased in both groups,HOMA-βwas increased,but the change of experimental group was more obvious(P<0.01).No obvious adverse reaction was found in the enrolled patients during treatment.Conclusionα-lipoic acid in combination with levothyroxine treatment of subclinical hypothyroidism merger in patients with diabetic retinopathy,RBP4 can obviously reduce the patients and blood sugar,blood lipid level,improve the function of islet beta cells.