糖尿病老年患者伴发亚临床甲状腺功能减退症对血管并发症的影响

摘要

目的 探讨糖尿病老年患者伴发亚临床甲状腺功能减退症(简称亚临床甲减)对外周动脉病变、视网膜病变、肾病等血管并发症的影响.方法 回顾性分析2014年1月至2016年1月收治的98例糖尿病老年患者临床资料,根据是否合并亚临床甲减分为甲状腺功能正常(DM)组46例和合并亚临床甲减组(DM+SCH)组52例.收集患者临床资料,比较生化指标、血管并发症情况,分析糖尿病伴发亚临床甲减老年患者外周动脉病变、视网膜病变、肾病等血管并发症的独立危险因素.结果 两组患者性别、年龄、糖尿病痛程、体质量指数、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血清肌酐(Scr)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、甲状腺过氧化物酶抗体(TPOAb)水平比较,差异无统计学意义(P＞0.05);DM+SCH组在总胆固醇(TC)、促甲状腺素(TSH)、甲状腺球蛋白抗体(TGAb)、24 h尿蛋白水平及动脉病变、视网膜病变、肾病发生率明显高于DM组(P＜0.05);Logistic分析提示高TC、高TSH、高TGAb、高24 h尿蛋白是糖尿病伴发亚临床甲减老年患者发生血管并发症的独立危险因素.结论 高TC、高TSH、高TGAb、高24 h尿蛋白是糖尿病伴发亚临床甲减老年患者发生血管并发症的独立危险因素,可增大血管并发症发生率,应及时诊断治疗,提高患者生存质量.%Objective To investigate the influence of complicating subclinical hypothyroidism(SCH) on the vascular complications such as peripheral arterial disease,retinopathy and nephropathy in elderly patients with diabetes mellitus(DM).Methods The clinical data of 98 patients with DM from January 2014 to January 2016 were retrospectively analyzed.The patients were divided into the thyroid function normal group(DM,46 cases) and complicating SCH group(DM + SCH,52 cases) according to whether complicating SCH.The clinical data of the patients were collected.Then the biochemical indexes and vascular complications were compared between the two groups.The independent risk factors of vascular complications such as peripheral arterial disease,retinopathy and nephropathy in elderly patients with DM were analyzed.Results Sex,age,DM duration,body mass index(BMI),TG,HDL-C,LDL-C,HbA1c,hs-CRP,Scr,FT3,FT4 and TPOAb had no statistically significant differences between the two groups (P＞0.05);the levels of TC,TSH,TGAb and 24 h urinary protein,and incidence rate of arterial disease,retinopathy and nephropathy in the DM + SCH group were significantly higher than those in the DM group (P＜0.05);the Logistic analysis showed that higher TC,higher TSH,higher TGAb and higher 24 h urinary protein were the independent risk factors of vascular complications in elderly patients with DM complicating SCH.Conclusion Higher TC,higher TSH,higher TGAb and higher 24 h urinary protein are the independent risk factors of vascular complications in elderly patients with DM complicating SCH,which can increase the occurrence of vascular complications,so should be timely diagnosed and treated to improve the patient's living quality.