糖尿病合并自身免疫性甲状腺疾病患者临床特征和特异性自身抗体水平分析  

Clinical characteristics and specific autoantibodies in patients with diabetes mellitus combined with autoimmune thyroid disease

作　　者：邹婧 赵志媛[2] 辛可嘉 彭静[2] 宋丹丹[2] 刘煜 

机构地区：[1]南京医科大学附属逸夫医院内分泌科,211100 [2]吉林大学第二医院内分泌科

出　　处：《中华糖尿病杂志》2018年第1期82-87,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金面上项目（81170746、81570704）;吉林省自然科学基金重点项目（20140101183JC）;吉林省创新团队项目（20150519013JH）;南京市国际联合研发项目（201605084）

摘　　要：目的通过比较单纯糖尿病和糖尿病合并自身免疫性甲状腺疾病（AITD）患者的临床特征和特异性自身抗体表达水平的差异，揭示糖尿病和AITD的相关性。方法2014年6月至2016年12月招募新发1型糖尿病（T1DM）患者162例及新发2型糖尿病（T2DM）患者314例，根据是否合并AITD分别将T1DM组和T2DM组分为2个亚组（合并1组和合并2组），其中AITD包括Graves病（GD）或桥本甲状腺炎（HT）。此外，将糖尿病合并AITD患者按甲状腺功能状态进行分组，包括临床甲状腺功能异常组、亚临床甲状腺功能异常组和甲状腺功能正常组，评价甲状腺功能对糖尿病患者临床指标的影响。检测空腹血糖（FPG）、C肽、糖化血红蛋白（HbA1c）、血生化、甲状腺功能等临床指标，采用放射配体法检测血清中甲状腺自身抗体、胰岛自身抗体及乳糜泻特异性抗体（tTGA）水平。计量资料比较采用t检验或单因素方差分析，计数资料比较采用χ2检验或Fisher精确检验。结果合并1组患者FPG和HbA1c均显著高于单纯T1DM患者[分别为（20.5±8.4）比（13.6±6.4） mmol/L、12.2%±2.2%比10.7%±2.9%，t=3.888、2.105，均P〈0.05]，而总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）则显著降低（t=2.870、3.749，均P〈0.05）。单纯T2DM患者的BMI显著高于合并2组患者（t=3.516，P〈0.001）。T1DM＋GD组和T1DM＋HT组患者的FPG均显著高于单纯T1DM患者（F=7.627，P〈0.05），且T1DM＋GD组患者HbA1c显著高于单纯T1DM患者（F=2.638，P〈0.05）。T1DM＋GD组患者的TC和LDL-C较单纯T1DM患者显著降低（F=4.357、5.482，均P〈0.05）。在糖尿病合并AITD患者中，临床甲状腺功能异常组患者的FPG和HbA1c均显著高于甲状腺功能正常患者[分别为（17.9±7.5）比（11.7±6.4） mmol/L、11.8%±2.6%比9.9%±2.6%，t=2.979、4.584，均P〈0.05]。此外，合并1组和合并2组患者血清谷氨酸脱羧酶抗体[72.7%（16/Objective To explore the relationship between diabetes and autoimmune thyroid disease （AITD） by evaluating the difference of clinical characteristics and the level of specific antibodies in diabetics associated with or without AITD.Methods From June 2014 to December 2016, subjects with newly diagnosed type 1 diabetes mellitus （T1DM, n=162） and type 2 diabetes mellitus （T2DM, n=314） were recruited, and they were divided into two subgroups including T1DM complicated with AITD （Combination group 1） and T2DM with AITD （Combination group 2）. AITD included Graves＇ disease （GD） or Hashimoto＇s thyroiditis （HT）. Furthermore, diabetics associated with AITD were classified according to thyroid function including clinical thyroid dysfunction, subclinical thyroid dysfunction and normal thyroid function. The effect of thyroid function on clinical indicators of diabetic patients was evaluated. Fasting blood glucose （FPG）, C peptide, glycated hemoglobin A1c （HbA1c）, biochemical tests and thyroid function of these subjects were measured. The level of thyroid autoantibodies, islet autoantibodies and specific antibody of celiac disease （tTGA） were detected by radio ligand assay. Quantitative data were analyzed by t-test or one-way analysis of variance and enumeration data were tested by Chi-square test or Fisher exact test.Results FPG and HbA1c in Combination group 1 were higher than those in T1DM alone group [（20.5±8.4） vs （13.6±6.4） mmol/L, 12.2%±2.2% vs 10.7%±2.9%, respectively, t=3.888, 2.105, both P〈0.05], while the level of total cholesterol （TC） and low density lipoprotein-cholesterol （LDL-C） obviously decreased in Combination group 1 （t=2.870, 3.749, both P〈0.05）. Combination group 2 showed significant lower BMI when compared with T2DM alone group （t=3.516, P〈0.001）. FPG level in T1DM＋GD group and T1DM＋HT group was significantly higher than that in T1DM alone group （F=7.627, P〈0.05）, and HbA1c level in T1DM＋GD group was higher than tha

关 键 词：糖尿病 1型 糖尿病 2型 自身免疫性甲状腺疾病 胰岛自身抗体 

分 类 号：R581[医药卫生—内分泌]