365例新诊断2型糖尿病患者聚类分型后甲状腺功能与胰岛功能分析

Analysis of thyroid function and islet function in 365 patients with newly diagnosed type 2 diabetes mellitus after clustering

目的参照瑞典Ahlqvist团队的聚类分型方式对新诊断T2DM患者进行分型,以探讨聚类分型下各亚型患者甲状腺功能和胰岛功能指标的特点。方法回顾性收集我院2019年1月—2022年6月365例新诊断T2DM患者的性别、年龄等一般资料及甲状腺功能、胰岛功能等临床资料。使用诊断年龄、BMI、糖化血红蛋白(HbA1c)、胰岛β细胞功能指数(HOMA2-β)和胰岛素抵抗指数(HOMA2-IR)这5个变量,对新诊断T2DM患者进行K均值聚类分析,分型成功后比较各亚型间甲状腺功能及胰岛功能的差异。结果聚类分型前:女性患者的诊断年龄、HOMA2-β、TSH值、甲状腺抗体阳性率、亚临床甲减患病率均高于男性,BMI、HbA1c、FPG、FT3值均低于男性,差异有统计学意义(P<0.05);INS、CP值在不同性别间比较差异无统计学意义(P>0.05)。聚类分型后各亚型甲状腺功能:SIDD亚型患者的T3、FT3水平均最低,MARD亚型患者的T4、FT4水平均最低,上述差异有统计学意义(P<0.05);而各亚型患者之间甲状腺抗体阳性率和甲状腺疾病患病率比较差异无统计学意义(P>0.05)。聚类分型后各亚型胰岛功能:SIDD亚型患者的胰岛功能和血糖控制情况较差,SIRD亚型患者的IR程度较重;MARD亚型患者的2 h CP最高,2 h INS在SIDD亚型患者中较高、MOD亚型患者中较低,上述差异有统计学意义(P<0.05)。结论聚类分型后各亚型特征稳定,可将新诊断2型糖尿病患者进行一个较为清晰的归类;各亚型间甲状腺功能指标无明显差异,胰岛功能指标特征差异显著。

Objective Patients with newly diagnosed type 2 diabetes mellitus(T2DM)were enrolled in this study.According to the clustering classification method by Ahlqvist's team in Sweden,the newly diagnosed T2DM patients were classified to explore the characteristics of thyroid function and islet function in patients with different subtypes of T2DM.Methods A retrospective study was conducted to collect general data such as gender,age and clinical data such as thyroid function and islet function of 365 patients with newly diagnosed T2DM.Five variables including age at diagnosis,body mass index(BMI),glycated hemoglobin A1c(HbA1c),isletβcell function index(HOMA2-β)and insulin resistance index(HOMA2-IR)were used to perform K-means cluster analysis in newly diagnosed T2DM patients.The differences of thyroid function and islet function among different subtypes were compared.Results Before clustering and classification,the age at diagnosis,HOMA2-β,TSH,positive rate of thyroid antibody and prevalence of subclinical hypothyroidism in female patients were higher than those in male patients.The values of BMI,HbA1c,FPG and FT3 were lower than those in men.The above differences were statistically significant(P<0.05).There was no significant difference in INS and CP between males and females(P>0.05).After clustering and classification,the levels of T3 and FT3 in SIDD subtype patients were the lowest,and the levels of T4 and FT4 in MARD subtype patients were the lowest,and the differences were statistically significant(P<0.05).However,there was no significant difference in the positive rate of thyroid antibodies and the prevalence of thyroid diseases among patients with different subtypes(P>0.05).After clustering and typing,patients with SIDD had worse islet function and glucose control,and patients with SIRD had more severe IR.The 2hCP was the highest in patients with MARD subtype,while the 2hINS was higher in patients with SIDD subtype and lower in patients with MOD subtype,and the differences were statistically significant(P<0.05).Conclusion After cluster typing,the characteristics of each subtype are stable,and the patients can be classified clearly.There is no significant difference in thyroid function among the subtypes,but there is significant difference in islet function among the subtypes.