亚临床甲状腺功能减退对老年人2型糖尿病视网膜病变的影响  

The relationship between subclinical hypothyroidism and diabetic retinopathy in elderly type 2 diabetic patients

作　　者：刘薇[1] 华琳[2] 张雪莲[1] 石敬[1] 谢荣荣[1] 杨金奎[1] 

机构地区：[1]首都医科大学附属北京同仁医院内分泌科,100730 [2]首都医科大学生物医学工程学院

出　　处：《中华老年医学杂志》2014年第11期1187-1190,共4页Chinese Journal of Geriatrics

基　　金：北京市自然科学基金项目（7142015）;国家自然科学基金项目（81300726）

摘　　要：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.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.

关 键 词：糖尿病 2型 甲状腺功能减退症 糖尿病视网膜病变 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]