糖尿病肾脏病合并亚临床甲状腺功能减退症患者的临床特点及中医证候分析

Clinical Characteristics and TCM Syndrome Analysis of Patients with Diabetic Kidney Disease Combined with Subclinical Hypothyroidism

目的:通过观察糖尿病肾脏病(DKD)合并亚临床甲状腺功能减退症(SCH)患者的临床特点,探讨分析合并SCH的DKD患者中医证候的临床特征和分布差异,对该类患者的辨证治疗提供一定价值。方法:通过回顾性分析选取北京中医药大学东直门医院肾病内分泌科近5年住院治疗的DKD患者484例,其中合并SCH者186例为DKD+SCH组(49例TSH≥10.0 mIu/L为重度组、137例4.0 mIu/L≤TSH≤10 mIu/L为轻度组),不合并SCH的DKD患者298例为单纯DKD组,2型糖尿病组患者246例,比较各组间患者性别、年龄、病程、甲状腺功能指标及抗体水平、肾功能、糖化血红蛋白、24 h尿蛋白定量、血脂等的差异,并分析DKD+SCH组患者中医证候的构成比及分布特点,探讨不同中医证候的相关危险因素。结果:合并SCH的DKD患者Scr、BUN、24 Upr、HbA1c、LDL-C、TC、TG、HDL-C水平均高于单纯DKD患者或2型糖尿病患者,差异有统计学意义(P<0.05);合并SCH的DKD患者脾肾阳虚证居多,且脾肾阳虚证患者FT4水平明显较低,TSH水平明显升高,差异有统计学意义(P<0.05);合并SCH的DKD患者进展至脾肾阳虚证危险因素分析发现,性别、BMI、SBP、TSH、FT4、Scr是发展至脾肾阳虚证的独立危险因素(P<0.05)。结论:DKD患者存在不同程度的甲状腺功能异常;合并SCH患者肾功能、血脂、糖化指标与单纯DKD患者或2型糖尿病患者相比存在差异性,其中医证型以脾肾阳虚证为主,不同中医证型间甲状腺功能存在差异性,且脾肾阳虚证、气滞血瘀证与DKD患者病情进展及SCH形成密切相关;临床中需正确管理生活方式,及时关注甲状腺功能变化,及早采用健脾温肾、活血化瘀法对症治疗,对延缓DKD病情进展,预防甲状腺功能减退的发生发展提供重要的参考价值。

Objective:By observing the clinical characteristics of patients with diabetic kidney disease(DKD)with subclinical hypothyroidism(SCH),the clinical characteristics and distribution differences of TCM syndrome of DKD patients with SCH are discussed and analyzed,which provides certain value to the syndrome differentiation treatment of such patients.Methods:Through retrospective analysis,484 DKD patients were hospitalized in the Department of Nephrology and Endocrinology of Dongzhimen Hospital of Beijing University of Chinese Medicine for recent 5 years,among which 186 patients with SCH were in the DKD+SCH group(The 49 cases where TSH≥10.0 mIu/L was severe and 137 cases were 4.0 mIu/L TSH 10 mIu/L was mild),A total of 298 DKD patients without SCH were included in the DKD alone group and 246 patients in the type 2 diabetes group.The differences in gender,age,disease duration,thyroid function index and antibody level,renal function,HbA1c,24 h urinary protein quantification,and blood lipid were compared,and the proportion and distribution characteristics of TCM syndrome in DKD+SCH group were analyzed,and the relevant risk factors of different TCM syndrome were explored.Results:The levels of Scr,BUN,24 Upr,HbA1c,LDL-C,combined DL-C,TC,TC,TG,and HDL-C were all higher than patients with DKD alone or type 2 diabetes,with a statistically significant difference(P<0.05);The DKD patients with SCH had mostly lower spleen and kidney Yang deficiency syndrome,and the significantly lower FT4 level and significantly higher TSH level were observed,with a statistically significant difference(P<0.05);Risk factor analysis of DKD patients complicated with SCH found that sex,BMI,SBP,TSH,FT4,and Scr were independent risk factors for progression to spleen and kidney Yang deficiency(P<0.05).Conclusion:DKD patients have different degrees of thyroid dysfunction;The renal function,blood lipid and saccharification indexes of SCH patients are different compared with simple DKD patients or type 2 diabetes patients.Their TCM syndrome is mainly spleen and kidney Yang deficiency syndrome,and their thyroid function is different among different TCM syndrome types,and the spleen and kidney Yang deficiency syndrome,qi stagnation and blood stasis syndrome are closely related to the progression of disease and SCH formation in DKD patients;In clinical practice,it is necessary to correctly manage lifestyle,pay attention to timely changes of thyroid function,and adopt symptomatic treatment of spleen invigorating kidney and promoting blood circulation and removing blood stasis as soon as possible,which can provide important reference value for delaying the progression of DKD and preventing the occurrence and development of hypothyroidism.