非酮症糖尿病患者糖化血红蛋白与红细胞分布宽度变异系数和甲状腺过氧化物酶抗体阳性率的相关性及其变化的影响因素研究  

Relationship of HbA_(1c) with RDW-CV and TPOAb and Associated Factors for HbA_(1c) Changes in Nonketotic Diabetic Patients

作　　者：彭韦霞[1] 贺佩祥[1] 刘丽君[1] 钟雅琴[1] 彭可[1] 李菊香[1] 徐雪辉[1] 丁婷 陈锋[1] 

机构地区：[1]湖南省益阳市中心医院内分泌科,413000

出　　处：《中国全科医学》2017年第36期4480-4483,4488,共5页Chinese General Practice

基　　金：湖南省医药卫生科研计划项目(B2014-174)

摘　　要：目的分析非酮症糖尿病患者糖化血红蛋白(HbA_(1c))与红细胞分布宽度变异系数(RDW-CV)和甲状腺过氧化物酶抗体(TPOAb)阳性率的相关性,并探讨HbA_(1c)变化的影响因素。方法选取2014年3月—2016年4月在益阳市中心医院内分泌科住院的符合纳入标准的非酮症糖尿病患者413例。依据患者HbA_(1c)进行分组:HbA_(1c)≤7.5%组(A组,n=128)、7.5%<HbA_(1c)<10.0%组(B组,n=190)、HbA_(1c)≥10.0%组(C组,n=95)。比较3组患者性别、年龄、病程、体质指数(BMI)、RDW-CV、低密度脂蛋白(LDL)、总胆固醇(TC)、24 h尿微量清蛋白(24 h UAE)、C反应蛋白(CRP)、空腹C肽(FCP)、餐后2 h C肽(PCP)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、谷氨酸脱羟酶抗体(GADA)阳性率、TPOAb阳性率,分析HbA_(1c)与上述指标的相关性及影响患者HbA_(1c)变化的独立危险因素。结果 B组、C组患者病程长于A组,RDW-CV大于A组,TSH及TPOAb阳性率高于A组(P<0.05);C组患者病程长于B组,RDW-CV大于B组,TSH、TPOAb阳性率高于B组(P<0.05)。Spearman秩相关分析结果显示,患者HbA_(1c)与病程、RDW-CV、TPOAb阳性率、TSH呈正相关(rs值分别为0.681、0.630、0.432、0.438,P值分别为<0.001、<0.001、0.001、0.001)。RDW-CV[OR=2.024,95%CI(1.237,4.103)]、TPOAb阳性率[OR=1.243,95%CI(1.134,1.548)]、TSH[OR=1.814,95%CI(1.567,3.234)]是非酮症糖尿病患者HbA_(1c)变化的独立危险因素(P<0.05)。结论非酮症糖尿病患者HbA_(1c)与RDW-CV、TPOAb阳性率呈正相关,且RDW-CV、TPOAb阳性率是患者HbA_(1c)变化的独立危险因素,因此,血糖控制越差,红细胞形态改变越明显,免疫性甲状腺疾病发生的可能性越大。Objective To investigate the relationship of glycated hemoglobin（ HbA_（1c）） with red blood cell distribution width（ RDW-CV） and thyroid peroxidase antibody（ TPOAb）,and the associated factors for HbA_（1c）changes in nonketotic diabetic patients. Methods According to the inclusion criteria, we selected 413 nonketotic diabetic patients who received inpatient treatment in Department of Endocrinology of Yiyang Central Hospital from March 2014 to April 2016. The patients were grouped according to HbA_（1c） level： HbA_（1c）≤7. 5%（ group A,n = 128）,7. 5% HbA_（1c） 10. 0%（ group B, n = 190）,HbA_（1c）≥10. 0%（ group C,n = 95）. The distribution of sex and age,course of nonketotic diabetes,body mass index（ BMI）,RDW-CV,low density lipoprotein（ LDL）, total cholesterol（ TC）,24-hour urine trace albumin（ 24 h UAE）, C-reactive protein（ CRP）,fasting C peptide（ FCP）,postprandial 2 h C-peptide（ PCP）,free triiodothyronine（ FT_3） and free thyroxine（ FT_4）,thyroid stimulating hormone（ TSH）,glutamic acid decarboxylase antibody（ GADA） positive rate,rate of abnormal TPOAb were compared among the 3 groups. The correlation between HbA_（1c）and the above indicators,and independent risk factors for HbA_（1c）changes in these patients were analyzed. Results Group A had shorter course of nonketotic diabetes,lower RDW-CV and lower TSH and rate of abnormal TPOAb than the other two groups（ P 0. 05）; group C had longer course of nonketotic diabetes,higher RDW-CV and higher TSH and rate of abnormal TPOAb compared with group B（ P 0. 05）. Spearman rank correlation analysis showed that HbA_（1c）was positively correlated with course of nonketotic diabetes,RDW-CV,rates of abnormal TPOAb and TSH（ rs= 0. 681,0. 630,0. 432 and 0. 438,respectively; P 0. 001,P 0. 001,P = 0. 001,P = 0. 001, respectively）. RDW-CV [OR = 2. 024,95% CI（ 1. 237,4. 103） ], rate of abnormal TPOAb level [OR =1. 243,95% CI（ 1. 134,1. 548） ],and TSH [OR = 1. 814,95

关 键 词：糖尿病 非酮症性 血红蛋白A 糖基化 红细胞分布宽度 甲状腺过氧化酶 影响因素分析 

分 类 号：R587.1[医药卫生—内分泌]