中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
4期
294-298
,共5页
糖尿病,2型%甲状腺功能减退症%糖尿病并发症
糖尿病,2型%甲狀腺功能減退癥%糖尿病併髮癥
당뇨병,2형%갑상선공능감퇴증%당뇨병병발증
Diabetes mellitus,type 2%Hypothyroidism%Diabetes complications
目的 探讨亚临床甲状腺功能减退(甲减)与2型糖尿病患者慢性并发症的相关性.方法 将临床资料相对完整的1062例2型糖尿病患者按照是否合并亚临床甲减分为2型糖尿病合并亚临床甲减组(糖尿病+甲减组)及2型糖尿病甲状腺功能正常组(糖尿病组),回顾性分析患者的一般资料,既往病史,合并糖尿病肾病、糖尿病视网膜病变、糖尿病周围神经病变、糖尿病外周血管病变、糖尿病足情况,辅助检查结果及实验室检查指标,并进行多因素非条件Logistic回归分析. 结果 糖尿病+甲减组患者年龄、糖尿病病程、并存冠心病、代谢指标、超敏C反应蛋白、尿微量白蛋白排泄率及促甲状腺激素水平明显高于糖尿病组；糖尿病+甲减组慢性并发症发病率较糖尿病组明显升高,分别为肾病62.8％对46.0％(P＜0.01),视网膜病变40.0％对28.7％(P＜0.05).周围神经病变33.8％对24.0％ (P＜0.05),外周动脉病变50.7％对38.0％ (P＜0.05),糖尿病足22.3％对12.3％(P＜0.01)；而踝臂指数、E峰/A峰值低于糖尿病组.经Logistic回归分析结果显示,高促甲状腺激素是糖尿病肾病(β=0.1273,OR=1.1361)、糖尿病足(β=0.1163,OR=1.1222)发生的独立危险因素. 结论 糖毒性可改变甲状腺自身免疫功能,亚临床甲减可促进糖尿病进程,是糖尿病肾病、糖尿病足发生的独立危险因素.老年2型糖尿病患者及病程较长者,应定期进行甲状腺功能检查,以便及早诊断和干预亚临床甲减,从而预防和延缓糖尿病慢性并发症的发生和发展.
目的 探討亞臨床甲狀腺功能減退(甲減)與2型糖尿病患者慢性併髮癥的相關性.方法 將臨床資料相對完整的1062例2型糖尿病患者按照是否閤併亞臨床甲減分為2型糖尿病閤併亞臨床甲減組(糖尿病+甲減組)及2型糖尿病甲狀腺功能正常組(糖尿病組),迴顧性分析患者的一般資料,既往病史,閤併糖尿病腎病、糖尿病視網膜病變、糖尿病週圍神經病變、糖尿病外週血管病變、糖尿病足情況,輔助檢查結果及實驗室檢查指標,併進行多因素非條件Logistic迴歸分析. 結果 糖尿病+甲減組患者年齡、糖尿病病程、併存冠心病、代謝指標、超敏C反應蛋白、尿微量白蛋白排洩率及促甲狀腺激素水平明顯高于糖尿病組；糖尿病+甲減組慢性併髮癥髮病率較糖尿病組明顯升高,分彆為腎病62.8％對46.0％(P＜0.01),視網膜病變40.0％對28.7％(P＜0.05).週圍神經病變33.8％對24.0％ (P＜0.05),外週動脈病變50.7％對38.0％ (P＜0.05),糖尿病足22.3％對12.3％(P＜0.01)；而踝臂指數、E峰/A峰值低于糖尿病組.經Logistic迴歸分析結果顯示,高促甲狀腺激素是糖尿病腎病(β=0.1273,OR=1.1361)、糖尿病足(β=0.1163,OR=1.1222)髮生的獨立危險因素. 結論 糖毒性可改變甲狀腺自身免疫功能,亞臨床甲減可促進糖尿病進程,是糖尿病腎病、糖尿病足髮生的獨立危險因素.老年2型糖尿病患者及病程較長者,應定期進行甲狀腺功能檢查,以便及早診斷和榦預亞臨床甲減,從而預防和延緩糖尿病慢性併髮癥的髮生和髮展.
목적 탐토아림상갑상선공능감퇴(갑감)여2형당뇨병환자만성병발증적상관성.방법 장림상자료상대완정적1062례2형당뇨병환자안조시부합병아림상갑감분위2형당뇨병합병아림상갑감조(당뇨병+갑감조)급2형당뇨병갑상선공능정상조(당뇨병조),회고성분석환자적일반자료,기왕병사,합병당뇨병신병、당뇨병시망막병변、당뇨병주위신경병변、당뇨병외주혈관병변、당뇨병족정황,보조검사결과급실험실검사지표,병진행다인소비조건Logistic회귀분석. 결과 당뇨병+갑감조환자년령、당뇨병병정、병존관심병、대사지표、초민C반응단백、뇨미량백단백배설솔급촉갑상선격소수평명현고우당뇨병조；당뇨병+갑감조만성병발증발병솔교당뇨병조명현승고,분별위신병62.8％대46.0％(P＜0.01),시망막병변40.0％대28.7％(P＜0.05).주위신경병변33.8％대24.0％ (P＜0.05),외주동맥병변50.7％대38.0％ (P＜0.05),당뇨병족22.3％대12.3％(P＜0.01)；이과비지수、E봉/A봉치저우당뇨병조.경Logistic회귀분석결과현시,고촉갑상선격소시당뇨병신병(β=0.1273,OR=1.1361)、당뇨병족(β=0.1163,OR=1.1222)발생적독립위험인소. 결론 당독성가개변갑상선자신면역공능,아림상갑감가촉진당뇨병진정,시당뇨병신병、당뇨병족발생적독립위험인소.노년2형당뇨병환자급병정교장자,응정기진행갑상선공능검사,이편급조진단화간예아림상갑감,종이예방화연완당뇨병만성병발증적발생화발전.
Objective To explore the impacts of subclinical hypothyroidism (SCH) on chronic complications of type 2 diabetes mellitus. Methods Totally 448 patients with type 2 diabetes were divided into diabetes plus SCH group (n=148) and control group (T2DM without SCH,n=300).The patient's general information,past medical history,chronic complications of diabetes including diabetic nephropathy ( DN ), diabetic retinopathy ( DR), diabetic peripheral neuropathy ( DPN ),peripheral arterial disease (PAD),diabetic foot (DF),ancillary and laboratory test results were analyzed. Results The age,duration of diabetes,incidence of coronary heart disease and levels of fasting C-peptide,total cholesterol,triacylglycerol,lipoprotein (a),hs-CRP,LDL-C,UAER and thyroid stimulating hormone (TSH) [(6.8 ± 3.5) mIU/L vs. (2.1 ± 1.3) mlU/L], antithyroidperoxidase antibody (TPO-Ab) [(253.6 ± 287.1 ) kU/L vs. (46.2 ± 80.7)] kU/L and thyroglobulin antibodies (TG-Ab) [( 57.8 ± 83.5 ) kU/L vs. ( 39.4 ± 45.3 ) kU/L] were significantly higher,but the ankle brachial index(ABI) and E/A value were lower in diabetes plus SCH group than in control group (P＜0.01 or 0.05).The prevalences of DN( 63％ vs.46％,P＜0.01),DR (40％vs.29％,P＜0.05),DPN (34％ vs.24％,P＜0.05),PAD (51％ vs.38％,P＜0.05) and DF (22％ vs.12％,P＜0.01) were higher in diabetes plus SCH group than in control group.Logistic regression analysis demonstrated that high level of TSH was independent risk factor for DN(β=0.1273,OR =1.1361) and DF (β=0.1153, OR =1.1222). Conclusions Subclinical hypothyroidism is an independent risk factor for diabetic nephropathy and diabetic foot,so the elderly with longer duration of diabetes should regularly be checked in thyroid ffunction to early find hypothyroidism.
