甲状腺功能与2型糖尿病眼底病变及肾脏病变的相关性分析

发布时间：2018-02-22 19:41

本文关键词： 2型糖尿病甲状腺功能 2型糖尿病眼底病变 2型糖尿病肾脏病变　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析甲状腺功能与2型糖尿病眼底病变及肾脏病变的关系,探讨甲状腺激素对2型糖尿病微血管病变发生发展的作用。方法:纳入2015年4月至2016年9月吉林大学第二医院内分泌科病房收治的1423例2型糖尿病患者,其中亚临床甲功异常组191例、临床型甲功异常组53例、甲功正常对照组1179例,收集患者的病史资料(年龄、性别、糖尿病病程、高血压、吸烟情况)、相关实验室指标(促甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺素、尿微量白蛋白、尿微量白蛋白肌酐比、血肌酐、肾小球滤过率、糖化血红蛋白、血脂、空腹C肽)及眼底镜检查结果,对收集的数据资料使用SPSS21.0统计软件进行统计分析,设检验水准a为0.05,以P0.05表示差异有统计学意义。结果:亚临床甲功异常组糖尿病视网膜病的患病率高于甲功正常组(49.2%和38.2%,p=0.004),在糖尿病视网膜病中,亚临床甲功异常组发生糖尿病增殖性视网膜病的比例高于甲功正常组(52.1%和36.2%,p=0.004);亚临床甲功异常组糖尿病肾病的患病率高于甲功正常组(37.2%和15.3%,p=0.000),在糖尿病肾病中,亚临床甲功异常组的肾小球滤过率低于甲功正常组,慢性肾脏病肾功分期高于甲功正常组(分别为2.18、1.62,p值为0.000),经多因素logistic回归校正性别、年龄、病程、吸烟、高血压、高血脂、Hb A1c、空腹C肽等因素后发现,亚临床甲功异常仍是糖尿病视网膜病(OR,1.607;95%CI,1.159-2.227;p=0.0044)和糖尿病肾病(OR,3.7;95%CI,2.581-5.305;p.0001)的独立危险因素;临床型甲功异常组糖尿病视网膜病的患病率低于甲功正常组(34.0%和38.2%,p=0.000),在糖尿病视网膜病中,临床型甲功异常组发生糖尿病增殖性视网膜病的比例与甲功正常组比较无统计学差异;但经多因素logistic回归校正混杂因素后发现,临床型甲功异常与糖尿病视网膜病无明确相关性;临床型甲功异常组糖尿病肾病的患病率高于甲功正常组(28.3%和15.3%,p=0.000),在糖尿病肾病中的肾小球滤过率低于甲功正常组,慢性肾脏病肾功分期高于甲功正常组(分别为2.07、1.62,p值为0.03),以上结果均有统计学意义;经多因素logistic回归校正性混杂因素后发现,临床型甲功异常仍是糖尿病肾病(OR,2.104;95%CI,1.1-4.024;p=0.0246)的独立危险因素。结论:1.在2型糖尿病中,亚临床甲状腺功能异常使糖尿病视网膜病和糖尿病肾病的患病率升高,并加重糖尿病视网膜病和糖尿病肾病。2.在2型糖尿病中,临床型甲状腺功能异常使糖尿病肾病的患病率升高,并加重糖尿病肾病,但与糖尿病视网膜病无明确相关。
[Abstract]:Objective: to analyze the relationship between thyroid function and fundus lesion and renal lesion in type 2 diabetes mellitus. Methods: from April 2015 to September 2016, 1423 patients with type 2 diabetes were treated in the Department of Endocrinology, Jilin University second Hospital. There were 191 cases of subclinical dysthyroidism group, 53 cases of clinical thyroid dysthyroidism group and 1179 cases of normal thyroid function control group. The patients' history data (age, sex, course of diabetes, hypertension) were collected. Smoking status, related laboratory indexes (thyroid stimulating hormone, free triiodothyronine, free thyroxine, urinary microalbumin, urinary albumin creatinine ratio, serum creatinine, glomerular filtration rate, glycosylated hemoglobin, blood lipids, Fasting C-peptide) and fundus examination results. The collected data were statistically analyzed by SPSS21.0 statistical software. Results: the prevalence of diabetic retinopathy in subclinical dysthyroidism group was higher than that in normal group (49.2%) and 38.2% (38.2%). The prevalence of diabetic proliferative retinopathy in subclinical dysthyroidism group was higher than that in normal group (52.1% and 36.2%), and the prevalence rate of diabetic nephropathy in subclinical dysthyroidism group was higher than that in normal group (37.2% and 15.3g%). The glomerular filtration rate in subclinical dysthyroidism group was lower than that in normal group, and the stage of renal function in chronic renal disease was higher than that in normal group (2.181.62 p = 0.000g, respectively). Sex, age, course of disease, smoking, hypertension were corrected by multivariate logistic regression. After hyperlipidemia, HbA1c and fasting C-peptide, it was found that subclinical hypothyroidism was still an independent risk factor for diabetic retinopathy (ORL 1.607 / 95 CIQ 1.159-2.227p0. 0044) and diabetic nephropathy (DNephropathy) 2.581-5.305 CI 2.581-5.305 (p. 0001). The prevalence rate of diabetic retinopathy in clinical type A dysthyroidism group was lower than that in normal group (34.0%) and 38.2% (38.2%). In diabetic retinopathy, the proportion of diabetic proliferative retinopathy in clinical type A dysthyroidism group was not significantly different from that in normal group. However, after correcting confounding factors by multivariate logistic regression, it was found that there was no clear correlation between clinical thyroid dysfunction and diabetic retinopathy. The prevalence rate of diabetic nephropathy in clinical type A dysthyroidism group was higher than that in normal group (28.3% and 15.3%), and the glomerular filtration rate in diabetic nephropathy was lower than that in normal group. The renal function stage of chronic kidney disease was higher than that of normal group (2.07 卤1.62p = 0.03P, respectively), the above results were all statistically significant, and were found by multivariate logistic regression correction of confounding factors. Clinical thyroid dysfunction is still an independent risk factor for diabetic nephropathy. Conclusion: 1. In type 2 diabetes mellitus, subclinical thyroid dysfunction increases the prevalence of diabetic retinopathy and diabetic nephropathy. In type 2 diabetes mellitus, the prevalence rate of diabetic nephropathy and diabetic nephropathy were increased due to abnormal thyroid function, but there was no clear correlation between clinical thyroid dysfunction and diabetic retinopathy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2

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