亚临床甲状腺功能减退与糖尿病视网膜病变相关性分析

Association between subclinical hypothyroidism and diabetic retinopathy

目的探讨亚临床甲状腺功能减退(subclinical hypothyroidism,SCH)与糖尿病视网膜病变(diabetic retinopathy,DR)的相关性。方法选取2019年1月至2022年3月笔者医院内分泌科收治的2型糖尿病(type 2 diabetes mellitus,T2DM)患者481例,根据患有DR的情况分为无DR组(n=327)、非严重DR组(n=92)和严重DR组(n=62)。比较各组临床资料,Spearman相关分析DR严重程度与其他指标的相关性。Logistic回归分析DR以及严重DR的影响因素。结果非严重DR组促甲状腺激素(Thyroid stimulating hormone,TSH)高于无DR组(P<0.05),游离甲状腺素(free thyroxine,FT_(4))低于无DR组(P<0.05)。严重DR组收缩压、舒张压、血肌酐(serum creatinine,Scr)均高于无DR组(P<0.05),游离三碘甲状腺原氨酸(free triiodothyronine,FT_(3))、FT_(4)均低于无DR组(P<0.05)。Spearman相关分析显示,DR严重程度与收缩压、舒张压、糖尿病病程、低密度脂蛋白胆固醇、Scr、TSH呈正相关(r=0.213、0.142、0.251、0.100、0.159、0.110,P<0.05),与FT_(3)、FT_(4)呈负相关(r=–0.103、–0.133,P<0.05)。Logistic回归分析显示,收缩压、糖尿病病程≥10年、低密度脂蛋白胆固醇、Scr、TSH>4.2mIU/L、FT_(4)是DR的影响因素。收缩压、Scr、TSH>4.2mIU/L是严重DR的影响因素。结论SCH是DR和严重DR的危险因素。

Objective To investigate the association between subclinical hypothyroidism(SCH)and diabetic retinopathy(DR).Methods A total of 481 patients with type 2 diabetes mellitus(T2DM)were enrolled in this study from our hospital during January 2019 to March 2022.Patients were divided into no-DR group(n=327),non-severe DR group(n=92)and severe DR group(n=62)according to whether they had DR and the severity of DR.The general data and biochemical indexes were compared among the groups.Spearman correlation analysis was used to evaluate the correlation between DR severity and related clinical indicators.Logistic regression analysis was performed to identify risk factors for odds of DR and severe DR.Results Thyroid stimulating hormone(TSH)was higher(P<0.05),while free thyroxine(FT_(4))was lower in non-severe DR group than in no-DR group(P<0.05).Systolic blood pressure(SBP),diastolic blood pressure(DBP)and serum creatinine(Scr)were higher(P<0.05),while free triiodothyronine(FT_(3))and FT_(4) were lower in severe DR than in no-DR group(P<0.05).Spearman correlation analysis showed that DR severity was positively correlated with SBP,DBP,duration of diabetes,low-density lipoprotein cholesterol(LDL-C),Scr and TSH(r=0.213,0.142,0.251,0.100,0.159,0.110,P<0.05)and negatively correlated with FT_(3) and FT_(4)(r=-0.103,-0.133,P<0.05).Logistic regression analysis showed that SBP,duration of diabetes≥10years,LDL-C,Scr,TSH>4.20mIU/L,FT_(4) were the influencing factors for DR,and SBP,Scr and TSH>4.20mIU/L were the influencing factors for severe DR.Conclusion SCH is not only a risk factor for DR,but also a risk factor for severe DR.