2型糖尿病合并亚临床甲状腺功能减退症116例临床分析及中医证型初探

发布时间：2018-01-05 14:04

本文关键词：2型糖尿病合并亚临床甲状腺功能减退症116例临床分析及中医证型初探　出处：《辽宁中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:观察合并亚临床甲状腺功能减退症(sub-clinical hypothyroidism,SCH)的2型糖尿病患者的临床特点,分析其对2型糖尿病患者可能产生的影响,并初步探讨不同中医证型间的合并SCH的2型糖尿病患者的临床特点与差异,以利于该类患者的对证治疗。资料与方法:筛选并回顾分析2014年1月1日至10月31日期间于辽宁中医药大学附属医院内分泌科住院治疗的2型糖尿病患者住院资料840例,将其中116例合并SCH者作为A组(13例TSH≥10mIU/L者为A1组、103例TSH10mIU/L者为A2组),其余724例不合并SCH的2型糖尿病患者作为B组,比较各组间患者年龄、病程、性别构成比、甲状腺功能指标及抗体水平、血脂及糖尿病相关并发症合并率的差异,并分析A组患者中医证型的构成比及分布特点;再以中医证型作为分组依据,比较A组患者临床特征的差异,并应用回归分析探讨不同中医证型的相关危险因素。结果:1.与不合并SCH的2型糖尿病患者相比,合并SCH者女性较多(P0.05),血清FT4水平较低(P0.05)而TSH、TgAb、TpoAb、CHOL及LDL-C水平较高(P0.05),合并糖尿病相关合并症的比例较高(P0.05);2.与TSH10mIU/L的SCH患者相比,血清TSH≥10mIU/L者年龄偏大(P0.05),2型糖尿病病程较长(P0.05),血清FT3及FT4水平较低(P0.05)而TSH、TgAb及TpoAb水平较高(P0.05),合并糖尿病相关并发症的比例较高(P0.05);3.116例合并SCH的2型糖尿病患者中,以证属阴阳两虚(42例,36.2%)及气阴两虚兼血瘀(34例,29.3%)者所占比例较大,气阴两虚证次之(26例,22.4%),阴阳两虚兼血瘀证者(14例,12.1%)比例较少;4.气阴两虚证者平均年龄较小(P0.05)、2型糖尿病病程较短(P0.05)、TG水平较高(P0.01)、较少合并糖尿病相关并发症;阴阳两虚证者,年龄及2型糖尿病病程居中,合并AS、DR、DKD及DPN的比例开始增高;气阴两虚兼血瘀及阴阳两虚兼血瘀证者,平均年龄较大(P0.05)且2型糖尿病病程较长(P0.05),合并各种糖尿病相关并发症的比例较高(P0.05);5.气阴两虚证型与年龄呈负相关关系,阴阳两虚证型与2型糖尿病病程呈负相关关系,气阴两虚兼血瘀及阴阳两虚兼血瘀二证与年龄、2型糖尿病病程及血清CHOL水平均呈正相关关系。结论:1.女性及甲状腺相关抗体水平较高的2型糖尿病患者更易合并SCH;2.合并SCH的2型糖尿病患者更易出现血脂代谢紊乱及合并糖尿病相关并发症,以TSH水平较高者表现更为明显;3.合并SCH的2型糖尿病患者初期证型以气阴两虚证为代表,随病变进展,其证型可能转化为阴阳两虚或气阴两虚兼血瘀,病变后期证型则以阴阳两虚兼血瘀证为代表。
[Abstract]:Objective: To observe the combined with subclinical hypothyroidism (sub-clinical hypothyroidism, SCH) the clinical characteristics of patients with type 2 diabetes, analyze its possible impact on patients with type 2 diabetes mellitus, and to explore the clinical features and the differences between different syndrome types of patients with SCH and type 2 diabetes patients, in order to verify the treatment this kind of patients. Materials and methods: screening and retrospective analysis from January 1, 2014 to October 31st in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Department of Endocrinology hospital treatment of patients with type 2 diabetes inpatients in 840 cases, among which 116 cases with SCH as group A (13 cases of TSH was larger than 10mIU/L in group A1, 103 cases of TSH10mIU/L were divided into A2 group). The remaining 724 patients with SCH in patients with type 2 diabetes as the B group, compared with age, duration, sex ratio, thyroid function and antibody level, blood lipids and diabetes related and The difference with complication rate, and analyze the constituent ratio and distribution characteristics of TCM Syndromes of A patients; the TCM syndrome type as the grouping criterion, the difference between the A groups of patients with clinical features, risk and application of regression analysis to explore the different TCM syndromes factors. Results: 1. compared with non SCH and type 2 diabetic patients with SCH were more women (P0.05), lower levels of serum FT4 (P0.05) and TSH, TgAb, TpoAb, CHOL and LDL-C level (P0.05), diabetes related complications (P0.05); a higher proportion of 2. compared with TSH10mIU/L SCH patients, serum TSH was larger than 10mIU/L age (P0.05), type 2 diabetes duration (P0.05), serum FT3 and FT4 levels were low (P0.05) and TSH, TgAb and TpoAb high level (P0.05), with a higher proportion of diabetes related complications (P0.05); 3.116 cases with SCH in patients with type 2 diabetes, the card is two (yin and yang deficiency in 42 cases, 3 6.2%) and yin deficiency and blood stasis (34 cases, 29.3%) were larger proportion, followed by Qi and yin deficiency (26 cases, 22.4%), two of yin and yang deficiency and blood stasis syndrome (14 cases, 12.1%) less proportion; the average age of 4. Qi and yin deficiency of smaller (P0.05), type 2 diabetes (short P0.05), higher levels of TG (P0.01), less complicated with diabetes related complications; deficiency of yin and yang two, and middle age, duration of type 2 diabetes mellitus complicated with AS, DR, DKD and DPN began to increase the proportion of yin deficiency and blood stasis; and two of yin and yang deficiency and blood stasis syndrome (P0.05), the average age and the duration of type 2 diabetes mellitus long (P0.05), with a higher proportion of all diabetes related complications (P0.05); there was a negative correlation between the ages of 5. and two Qi and yin deficiency, yin and yang deficiency type is negatively correlated with the duration of type 2 diabetes mellitus, Qi Yin deficiency and blood stasis and blood stasis syndrome of yin and Yang of the two virtual and two with type 2 diabetes and age. Serum CHOL levels were positively correlated. Conclusion: 1. women and thyroid related antibody levels were higher in patients with type 2 diabetes more likely to merge with SCH SCH; 2. patients with type 2 diabetes prone to dyslipidemia and diabetes related complications, with higher level of TSH is more obvious; 3. with the initial SCH in patients with type 2 diabetes syndromes of two Qi and yin deficiency syndrome, with the progress of the disease, the syndrome may be converted to the Yin and Yang of the two virtual or Qi Yin deficiency and blood stasis syndrome, the late lesions in two of yin and yang deficiency and blood stasis syndrome.

【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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