老年2型糖尿病合并亚临床甲状腺功能减退患者的临床特点

Clinical characteristics in elderly patients with type 2 diabetes mellitus complicated with subclinical hypothyroidism

目的:探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)合并亚临床甲状腺功能减退(subclinical hypothyroidism,SCH)患者48例的临床特点。方法:回顾性分析2020年2月至2022年1月在池州市第二人民医院诊治的96例老年T2DM患者的临床资料,按照是否合并SCH,分为合并SCH组(48例)与未合并SCH组(48例)。分析2组性别、高血压、糖尿病病程、药物史等一般资料,总结老年T2DM合并SCH的临床特点。检测并比较2组糖代谢[包括餐后2 h血糖(2-hour postprandial blood glucose,2hPG)、糖化血红蛋白(hemoglobin A1c,HbA1c)]及脂代谢[包括胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白(low-density lipoprotein,LDL)、高密度脂蛋白(high-density lipoprotein,HDL)]水平。结果:合并SCH组的高血压合并率、他汀类使用率、糖尿病病程明显高/长于未合并SCH组,双胍类使用率明显低于未合并SCH组,差异均有统计学意义(均P<0.05);合并SCH组2hPG、HbA1c、TC、TG、LDL水平明显高于未合并SCH组,HDL水平明显低于未合并SCH组,差异均有统计学意义(均P<0.05);Pearson相关分析显示TSH水平同2hPG、HbA1c、LDL呈正相关(分别r=0.171、0.001、0.153,均P<0.05);多因素logistic回归分析显示双胍类、糖尿病病程、2hPG、HbA1c、TC、TG、LDL、HDL为老年T2DM患者出现SCH的独立危险因素(均P<0.05)。结论:老年T2DM合并SCH患者具有糖尿病病程长、他汀类使用率高、双胍类使用率低、高血压合并率高的特点,且更容易发生糖脂代谢紊乱。

Objective:To investigate the clinical features of 48 elderly patients with type 2 diabetes mellitus(T2DM)complicated with subclinical hypothyroidism(SCH).Methods:The clinical data of 96 elderly patients with T2DM diagnosed and treated in the Second People’s Hospital of Chizhou from February 2020 to January 2022 were retrospectively analyzed.They were divided into a combined SCH group(48 cases)and a non-SCH group(48 cases)according to whether they were combined with SCH.The general data such as gender,hypertension,duration of diabetes mellitus,and drug history in the 2 groups were analyzed,and the clinical characteristics of senile T2DM complicated with SCH were summarized.Glucose metabolism[including 2 h postprandial blood glucose(2hPG),and glycosylated hemoglobin(HbA1c)]and lipid metabolism[including cholesterol(TC),triglyceride(TG),low-density lipoprotein(LDL),and high-density lipoprotein(HDL)]levels were detected and compared between the 2 groups.Results:Compared with the non-SCH group,the combined rate of hypertension,the rate of statin use,and the duration of diabetes were significantly higher/longer,and the biguanide usage rate was significantly lower(P<0.05);the levels of 2hPG,HbA1c,TC,TG,and LDL were significantly higher,and the HDL level was significantly lower in the combined SCH group(all P<0.05).Pearson correlation analysis showed that TSH levels were positively correlated with 2hPG,HbA1c,and LDL(r=0.171,0.001,0.153,respectively,all P<0.05);multivariate logistic regression analysis showed that biguanide,duration of diabetes,2hPG,HbA1c,TC,TG,LDL,and HDL were independent risk factors for SCH in elderly T2DM patients(all P<0.05).Conclusion:Elderly T2DM patients with SCH have the characteristics of long duration of diabetes,high statin use rate,low biguanide use rate,high hypertension rate,and who are more likely to develop glucose and lipid metabolism disorders.