老年糖尿病患者甲状腺激素变化及其临床意义
노년당뇨병환자갑상선격소변화급기림상의의
Changes of serum thyroid hormone in elder patients with type 2 diabetes mellitus and its clinical significance
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2014年 13期 44-48 ,共5页

    罗益文

    라익문

    老年人%糖尿病%甲状腺激素类%超声检查 老年人%糖尿病%甲狀腺激素類%超聲檢查
    노년인%당뇨병%갑상선격소류%초성검사
    Aged%Diabetes mellitus%Thyroid hormones%Ultrasonography
    目的 探讨老年糖尿病患者甲状腺激素的变化及其临床意义.方法 选取436例老年糖尿病患者(老年糖尿病组)及312例非糖尿病患者(对照组)进行甲状腺超声检查,检测两组的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血脂等指标.同时测定血清总三碘甲腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)及抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)水平,按不同HbA1c水平分为HbA1c＜7.5％组(132例)、HbA1c 7.5％～9.0％组(211例),HbA1c＞ 9.0％组(93例);按不同病程分为病程≤1年组(65例)、1年＜病程≤5年组(133例)、5年＜病程≤10年组(195例)及病程＞ 10年组(43例),对比分析各组患者甲状腺功能及甲状腺超声的变化.结果 老年糖尿病组甲状腺功能异常发生率为19.7％ (86/436),甲状腺功能减退症与亚临床甲状腺功能减退症发生率明显高于甲状腺功能亢进症与亚临床甲状腺功能亢进症发生率[14.4％ (63/436)比5.3％ (23/436)],差异有统计学意义(P＜0.05).与对照组比较,老年糖尿病组TT3、FT3水平明显降低[(1.27±0.20) nmol/L比(1.60±0.34)nmol/L、(3.71±0.49)pmol/L比(4.45±0.62) pmol/L],TGAb、TPOAb水平及甲状腺体积明显增高[(74.73±41.25) kU/L比(40.05±18.28)kU/L、(87.46±36.81) kU/L比(42.39±20.84) kU/L、(17.1±3.0)ml比(13.7±2.5) ml],甲状腺肿大及存在甲状腺结节比例升高[17.66％(77/436)比4.17％(13/312),59.86％(261/436)比29.49％ (92/312)],差异均有统计学意义(P＜0.05).随着HbA1c的升高,TSH及TT3水平逐渐下降(P＜0.05).HbA1c＞ 9.0％组的FT3水平明显低于HbA1c＜ 7.5％组及HbA1c 7.5％～9.0％组[(3.46±0.39)pmol/L比(3.73±0.47)、(3.75±0.49) pmol/L] (P＜ 0.05),甲状腺肿大、存在甲状腺结节及甲状腺回声异常的比例明显高于HbA1c＜7.5％组及HbA1c 7.5％～9.0％组[36.6％ (34/93)比11.4％ (15/132)、13.3％ (28/211);90.3％ (84/93)比50.0％ (66/132)、52.6％(111/211);45.2％(42/93)比12.9％(17/132)、15.2％(32/211)],差异有统计学意义(P＜0.05).随着病程延长,TSH、TGAb水平逐渐增高,而TT3、FT3水平逐渐下降.结论 老年糖尿病患者常合并甲状腺功能异常,应注意筛查和随访.甲状腺功能对老年糖尿病病情的评估具有一定的临床意义.
    목적 탐토노년당뇨병환자갑상선격소적변화급기림상의의.방법 선취436례노년당뇨병환자(노년당뇨병조)급312례비당뇨병환자(대조조)진행갑상선초성검사,검측량조적공복혈당(FPG)、당화혈홍단백(HbA1c)、혈지등지표.동시측정혈청총삼전갑선원안산(TT3)、총갑상선소(TT4)、유리삼전갑선원안산(FT3)、유리갑상선소(FT4)、촉갑상선격소(TSH)급항갑상선과양화물매항체(TPOAb)、항갑상선구단백항체(TGAb)수평,안불동HbA1c수평분위HbA1c＜7.5％조(132례)、HbA1c 7.5％～9.0％조(211례),HbA1c＞ 9.0％조(93례);안불동병정분위병정≤1년조(65례)、1년＜병정≤5년조(133례)、5년＜병정≤10년조(195례)급병정＞ 10년조(43례),대비분석각조환자갑상선공능급갑상선초성적변화.결과 노년당뇨병조갑상선공능이상발생솔위19.7％ (86/436),갑상선공능감퇴증여아림상갑상선공능감퇴증발생솔명현고우갑상선공능항진증여아림상갑상선공능항진증발생솔[14.4％ (63/436)비5.3％ (23/436)],차이유통계학의의(P＜0.05).여대조조비교,노년당뇨병조TT3、FT3수평명현강저[(1.27±0.20) nmol/L비(1.60±0.34)nmol/L、(3.71±0.49)pmol/L비(4.45±0.62) pmol/L],TGAb、TPOAb수평급갑상선체적명현증고[(74.73±41.25) kU/L비(40.05±18.28)kU/L、(87.46±36.81) kU/L비(42.39±20.84) kU/L、(17.1±3.0)ml비(13.7±2.5) ml],갑상선종대급존재갑상선결절비례승고[17.66％(77/436)비4.17％(13/312),59.86％(261/436)비29.49％ (92/312)],차이균유통계학의의(P＜0.05).수착HbA1c적승고,TSH급TT3수평축점하강(P＜0.05).HbA1c＞ 9.0％조적FT3수평명현저우HbA1c＜ 7.5％조급HbA1c 7.5％～9.0％조[(3.46±0.39)pmol/L비(3.73±0.47)、(3.75±0.49) pmol/L] (P＜ 0.05),갑상선종대、존재갑상선결절급갑상선회성이상적비례명현고우HbA1c＜7.5％조급HbA1c 7.5％～9.0％조[36.6％ (34/93)비11.4％ (15/132)、13.3％ (28/211);90.3％ (84/93)비50.0％ (66/132)、52.6％(111/211);45.2％(42/93)비12.9％(17/132)、15.2％(32/211)],차이유통계학의의(P＜0.05).수착병정연장,TSH、TGAb수평축점증고,이TT3、FT3수평축점하강.결론 노년당뇨병환자상합병갑상선공능이상,응주의사사화수방.갑상선공능대노년당뇨병병정적평고구유일정적림상의의.
    Objective To investigate the changes of serum thyroid hormone in elder patients with type 2 diabetes mellitus and its chnical significance.Methods A total of 436 elder patients with type 2 diabetes mellitus (elder diabetes mellitus group) and 312 cases without diabetes mellitus (control group)were underwent thyroid ultrasound.For all of the patients,clinical data including fasting plasma glucose (FPG),hemoglobin A1c (HbA1c),serum lipid were tested.Serum thyroid hormone such as total triio dothyronine (TT3),total thyroxine (TT4),free triio dothyronine (FT3),free thyroxine (FT4),thyrotrophin (TSH),antithyroglobulin antibody (TGAb) and anti-thyroid peroxidase antibody (TPOAb) were measured simultaneously.The patients were divided into 3 groups according to the level of HbA1c:HbA1c ＜ 7.5％ group(132 cases),HbA1c 7.5％-9.0％ group(211 cases) and HbA1c ＞ 9.0％ group(93 cases).And they were also divided into 4 groups according to the level of duration:duration ≤ 1 year group (65 cases),1 year ＜ duration ≤ 5 years group(133 cases),5 years ＜ duration≤ 10 years group(195 cases) and duration ＞ 10 years group (43 cases).The levels of thyroid function and thyroid ultrasound were compared among different groups.Results The incidence of abnormal structure of thyroid was 19.7％ (86/436) and the incidence of hypothyroidism and sub-clinical hypothyroidism was higher than the incidence of hyperthyroidism and sub-clinical hyperthyroidism [14.4％ (63/436) vs.5.3％ (23/436)] in elder diabetes mellitus group,and there was significant difference(P＜ 0.05).Compared with that in control group,TT3,FT3 was decreased [(1.27 ± 0.20) nmol/L vs.(1.60 ± 0.34) nmol/L,(3.71 ± 0.49) pmol/L vs.(4.45 ± 0.62)pmol/L],TGAb,TPOAb and thyroid gland volume was increased [(74.73 ±41.25) kU/L vs.(40.05 ± 18.28) kU/L,(87.46 ± 36.81) kU/L vs.(42.39 ± 20.84) kU/L,(17.1 ± 3.0) ml vs.(13.7 ± 2.5) ml],the ratio of thyroid swelling and thyroid nodule was increased [17.66％(77/436) vs.4.17％(13/312),59.86％ (261/436) vs.29.49％ (92/312)],and there was significant difference (P ＜ 0.05).While the levels of HbA 1c increased,the levels of TT3 and TSH decreased simultaneously.The level of FT3 in HbA1c ＞ 9.0％ group was lower than that in HbA1c ＜ 7.5 ％ group and HbA1c 7.5 ％-9.0％ group [(3.46 ± 0.39) pmol/L vs.(3.73 ± 0.47),(3.75 ± 0.49) pmol/L] (P ＜ 0.05),the ratio of thyroid swelling,thyroid nodule and abnormal thyroid echo in HbA1c ＞ 9.0％ group was higher than that in HbA1c ＜ 7.5％ group and HbA1c 7.5％-9.0％ group [36.6％ (34/93) vs.11.4％ (15/132),13.3％ (28/211);90.3％ (84/93) vs.50.0％ (66/132),52.6％ (111/211) ;45.2％(42/93) vs.12.9％(17/132),15.2％(32/211)],and there was significant difference (P ＜0.05).When the duration of diabetes increased,the levels of TT3,FT3 decreased and the levels of TSH,TGAb increased simultaneously.Conclusions It is common that elder patients with type 2 diabetes mellitus always follow with thyroid dysfunction,which should be checked out and followed up.The levels of thyroid function are important for assessing the glucose metabolism in elder patients with type 2 diabetes mellitus.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문