2型糖尿病患者甲状腺功能变化情况及临床特点分析

发布时间：2018-11-12 08:59

【摘要】：目的:研究2型糖尿病患者的临床资料,分析2型糖尿病患者中甲状腺疾病分布情况及患病特点,并分析血清生化指标在甲状腺疾病状态下的变化情况,寻找其可能的影响因素以利及早进行相关干预。方法:回顾性查阅2015年-2016年期间在广西医科大学第一附属医院内分泌代谢病科住院的2型糖尿病患者298例,根据疾病状态分为2型糖尿病甲功正常组、甲减组(包含临床甲减和亚临床甲减)和甲亢组(包含临床甲亢和亚临床甲亢)。以甲功正常组209例患者为对照组,以89例甲功异常患者作为病例组,其中检测甲状腺自身免疫抗体的有218例。收集年龄、病程、血脂、糖化血红蛋白、甲状腺自身抗体等指标,分析以上资料与甲状腺功能状态的相关性。结果:本研究共纳入298例2型糖尿病患者,其中甲功异常为89/298例,患病率为29.9%,包括甲亢患者42/298例(14.1%),甲减患者47/298例(15.8%),亚临床甲减、临床甲减、亚临床甲亢及临床甲减患病率分别为11.4%、4.4%、8.7%、5.4%,其中亚临床甲减组所占比例最大。在本研究的298例患者中,按甲状腺功能状态分为甲功正常组、甲减组、甲亢组,分析结果示甲减组与甲状腺功能正常组比较,甲减组的年龄、总胆固醇、TSH均较甲状腺功能正常组高,甲减组HbA1C、TT3、TT4、FT3、FT4较甲功正常组低,差异均具有统计学意义。甲亢组与甲状腺功能正常组相比,甲亢组总胆固醇、TSH低于甲状腺功能正常组,TT3、TT4、FT3、FT4均较甲功正常组高,差异具有统计学意义。甲状腺功能异常患者中TMAb、TGAb、TRAb阳性率较甲功正常组有显著性差异,分别为0.000、0.000、0.007。结论:1、2型糖尿病患者甲状腺功能异常的患病率为29.9%,且2型糖尿病患者年龄越大,甲状腺功能减退患病率增加,建议2型糖尿病患者进行甲状腺疾病筛查,年龄越大者更应引起重视。2、在2型糖尿病中,患者机体处于不同的甲状腺功能状态下时,总胆固醇会随之发生变化,用药时应注意监测。3、2型糖尿病合并甲减较2型糖尿病甲功正常患者的HbA1C低,建议2型糖尿病合并甲状腺功能减退的患者更应注意监测血糖。4、甲状腺自身抗体异常的2型糖尿病患者出现甲状腺功能异常的概率较甲功正常组高,建议目前甲功正常单甲状腺自身抗体异常的2型糖尿病患者应常规检测甲状腺功能,并定期随访。
[Abstract]:Objective: to study the clinical data of type 2 diabetes mellitus, to analyze the distribution and characteristics of thyroid disease in type 2 diabetes mellitus, and to analyze the changes of serum biochemical indexes in thyroid disease. To find its possible influencing factors to facilitate early intervention. Methods: a total of 298 patients with type 2 diabetes mellitus who were hospitalized in the Department of Endocrine and Metabolism, first affiliated Hospital of Guangxi Medical University, from 2015 to 2016, were divided into normal type 2 diabetic group according to their disease status. Hypothyroidism group (including clinical hypothyroidism and subclinical hypothyroidism) and hyperthyroidism group (including clinical hyperthyroidism and subclinical hyperthyroidism). 209 cases of normal thyroid function group were taken as control group and 89 cases of thyroid dysthyroidism group as case group. 218 cases of thyroid autoimmune antibody were detected. Age, course of disease, blood lipid, glycosylated hemoglobin and thyroid autoantibodies were collected to analyze the correlation between the above data and thyroid function. Results: a total of 298 patients with type 2 diabetes were included in this study. Among them, there were 89 / 298 cases of dysthyroidism and 29.9% of the total prevalence rate, including 42 / 298 cases (14.1%) of hyperthyroidism and 47 / 298 cases (15.8%) of hypothyroidism. The prevalence rates of subclinical hypothyroidism, subclinical hyperthyroidism and clinical hypothyroidism were 11.44.4and 8.7and 5.4respectively, among which the subclinical hypothyroidism group accounted for the largest proportion. According to thyroid function, 298 patients were divided into normal thyroid function group, hypothyroidism group and hyperthyroidism group. The results showed that the age, total cholesterol of hypothyroidism group were higher than that of normal thyroid function group. TSH was higher than normal thyroid function group, and HbA1C,TT3,TT4,FT3,FT4 in hypothyroidism group was lower than that in normal thyroid function group, the difference was statistically significant. The total cholesterol and TSH of hyperthyroidism group were lower than that of normal thyroid function group, and the TT3,TT4,FT3,FT4 of hyperthyroidism group was higher than that of normal thyroid function group, the difference was statistically significant. The positive rate of TMAb,TGAb,TRAb in the patients with abnormal thyroid function was significantly higher than that in the normal thyroid function group (0.0000.0000.000,0.007). Conclusion: 1 the prevalence of thyroid dysfunction in patients with type 2 diabetes mellitus is 29.9. the older type 2 diabetes patients are, the higher the prevalence of hypothyroidism is. It is suggested that type 2 diabetes patients should be screened for thyroid diseases. The older you get, the more important it is. 2. In type 2 diabetes, when the body is in a different thyroid function, the total cholesterol changes. The HbA1C of patients with type 3 diabetes mellitus with hypothyroidism was lower than that of patients with normal hypothyroidism of type 2 diabetes, and it was suggested that patients with type 2 diabetes mellitus with hypothyroidism should pay more attention to monitoring blood glucose. Type 2 diabetic patients with abnormal thyroid autoantibodies were more likely to have thyroid dysfunction than those with normal thyroid function. It was suggested that type 2 diabetes patients with normal thyroid autoantibodies should be routinely tested for thyroid function. The patients were followed up regularly.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R581

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