CAJ | 학술논문

目的探讨亚临床甲状腺功能减退症(SCH)对老年2型糖尿病患者视网膜病变(DR)的影响. 方法选取因2型糖尿病住院患者1170例,经系统抽样确定研究对象后,对所有老年患者行甲状腺功能、生化指标及馒头餐试验并记录C肽水平(CP0～3),使用TOPCON眼底照相设备行眼底照相,眼底镜复核. 结果据不同促甲状腺激素(TSH)水平将入选患者分为甲状腺功能正常组(甲功正常组,TSH≤4 mU/L)和SCH组(TSH＞4 mU/L),SCH又分为轻度SCH组(TSH＞4～10 mU/L)和重度SCH组(TSH＞10 mU/L).SCH组游离甲状腺素(FT4)水平显著降低[(13.91±2.17)pmol/L比(16.55±2.81) pmol/L,P＜0.001],各点C肽(CP0～3)显著高于甲功正常组(P0～3值分别为0.001、0.012、0.004、0.001),SCH组与甲功正常组眼底病变进展程度比较,差异有统计学意义(P左眼＝0.018,P右眼=0.013). 结论合并SCH的老年2型糖尿病患者DR发生率更高,FT4水平下降及基础C肽水平升高为其主要原因.
목적 탐토아림상갑상선공능감퇴증(SCH)대노년2형당뇨병환자시망막병변(DR)적영향. 방법 선취인2형당뇨병주원환자1170례,경계통추양학정연구대상후,대소유노년환자행갑상선공능、생화지표급만두찬시험병기록C태수평(CP0～3),사용TOPCON안저조상설비행안저조상,안저경복핵. 결과 거불동촉갑상선격소(TSH)수평장입선환자분위갑상선공능정상조(갑공정상조,TSH≤4 mU/L)화SCH조(TSH＞4 mU/L),SCH우분위경도SCH조(TSH＞4～10 mU/L)화중도SCH조(TSH＞10 mU/L).SCH조유리갑상선소(FT4)수평현저강저[(13.91±2.17)pmol/L비(16.55±2.81) pmol/L,P＜0.001],각점C태(CP0～3)현저고우갑공정상조(P0～3치분별위0.001、0.012、0.004、0.001),SCH조여갑공정상조안저병변진전정도비교,차이유통계학의의(P좌안＝0.018,P우안=0.013). 결론 합병SCH적노년2형당뇨병환자DR발생솔경고,FT4수평하강급기출C태수평승고위기주요원인.
Objective To investigate the relationship between subclinical hypothyroidism (SCH) and diabetic retinopathy (DR) in elderly type 2 diabetic patients.Methods 1170 hospitalized patients with type 2 diabetes mellitus were enrolled in our study.After identified by systematic sampling,all the elderly patients received examinations of thyroid function,biochemical indexes,steamed bread meal test and C-peptide releasing test.The serious degree of DR was observed through digital fundus photography and ophthalmofundoscope.The relationship between SCH and DR was analyzed.Results All the subjects were divided into two subgroups:euthyroid group(TSH≤4mU/L)and subclinical hypothyroidism (SCH) group (mild SCH group,TSH ＞4～10 mU/L; serious SCH group,TSH＞10 mU/L).Free thyroxine (FT4) was significantly lower in SCH group than in euthyroid group[(13.91±2.17) pmol/L vs.(16.55±2.81)pmol/L,P＜0.001].The levels of basal (CP0) and post glucose-challenge (CP1-3) C-peptide were significantly higher in SCH group than in euthyroid group (P0-3 value:0.001,0.012,0.004,0.001).There were significant differences in the progress of diabetic retinopathy between SCH and euthyroid groups (retinopathy-L,P=0.018; retinopathy-R P=0.013).Conclusions Elderly type 2 diabetic patients with SCH have a higher incidence of diabetic retinopathy (DR).The elevated FT4 level and decreased basal C-peptide level are probably the main reasons.