成年1型糖尿病合并自身免疫性甲状腺疾病的患病情况及糖脂代谢差异  

Prevalence and metabolic control in adult patients with autoimmune thyroid disease and type 1 diabetes mellitus

作　　者：周泳雯 严晋华[1] 郑雪瑛 骆斯慧 凌萍 吴泽开 刘宏霞[1] 甘露 沈玄韬 杨黛稚[1] 姚斌[1] 翁建平 Zhou Yongwen;Yan Jinhua;Zheng Xueying;Luo Sihui;Ling Ping;Wu Zekai;Liu Hongxia;Gan Lu;Shen Xuantao;Yang Daizhi;Yao Bin;Weng Jianping(Department of Endocrinology and Metabolism,the Third Affiliated Hospital of Sun Yat-sen University,Guangdong Provincial Key Laboratory of Diabetology,Guangzhou 510630,China;Department of Endocrinology and Metabolism,the First Affiliated Hospital University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中山大学附属第三医院内分泌与代谢病学科广东省糖尿病防治重点实验室,广州510630 [2]中国科学技术大学附属第一医院(安徽省立医院)内分泌科,合肥230001

出　　处：《中华糖尿病杂志》2020年第8期600-605,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家重点研发计划项目(2017YFC1309600,2016YFC1305002);广东省自然科学基金(2018A030313251)。

摘　　要：目的探讨成年1型糖尿病(T1DM)合并自身免疫性甲状腺疾病(AITD)的患病及其代谢情况。方法回顾性选取广东省T1DM转化医学研究2011年6月至2018年11月登记的≥18岁的患者1158例,其中男524例,女634例,分为单纯T1DM组(n=982)和合并AITD组(n=176),进一步根据入组时甲状腺功能将合并AITD组分为甲状腺功能亢进组(n=42)、减退组(n=31)和正常组(n=103),分析患者入组及随访1年后的糖化血红蛋白(HbA1c)、体质指数(BMI)、促甲状腺激素(TSH)、血压等指标变化,并比较不同分组间随访1年前后的代谢指标水平。采用t检验、Mann-Whitney U检验或χ^2检验进行统计学分析。结果起病时,合并AITD组代谢紊乱更严重。随访1年后,两组HbA1c均较入组时明显下降[合并AITD组:8.40%(7.03%,10.78%)比7.65%(6.60%,8.93%),P<0.01;单纯T1DM组:8.50%(7.20%,10.80%)比7.75%(6.70%,9.10%),P<0.01],BMI及胰岛素敏感指数较入组时均增高,但两组间差异无统计学意义(均P>0.05)。随访1年后,合并AITD组亢进组TSH水平仍显著低于正常组[0.15(0.01,0.39)比1.92(1.34,3.17)nmol/L,P<0.05];与减退组和正常组不同的是,HbA1c未见显著改善;此外,减退组BMI、收缩压及舒张压显著高于正常组[(22.37±2.89)比(20.71±2.77)kg/m2,120(110,129)比111(103,122)mmHg,78(75,81)比70(63,77)mmHg,均P<0.05](1 mmHg=0.133 kPa),余指标差异未见统计学意义(均P>0.05)。结论成年AITD合并T1DM患者起病时代谢紊乱更严重;随访1年后,AITD组中甲状腺功能亢进的患者糖代谢未见改善,甲状腺功能减退的患者1年后更易于出现增重及血压升高。Objective To investigate the prevalence of the autoimmune thyroid disease(AITD)and the metabolic control in adult patients with type 1 diabetes mellitus(T1DM).Methods A total of 1158 adult patients(≥18 years;male/female,524/634)registered in the Guangdong T1DM Translational Study from June 2011 to November 2018 were selected into the analysis,with 982 patients in T1DM only group and 176 patients in comorbid AITD group.According to thyroid function at enrollment,patients with comorbid AITD were further divided into hyperthyroidism group(n=42),hypothyroidism group(n=31)and normal thyroid function group(n=103).Biochemical information such as glycated hemoglobin A1c(HbA1c),body mass index(BMI),thyroid stimulating hormone(TSH)were collected at enrollment and one-year follow-up.Changes of indexs at one-year follow up were further analyzed between groups.Statistical analysis was performed using t test,Mann-Whitney U or chi-square test.Results At onset,patients with comorbid AITD presented more serious metabolic disorder.After one-year follow-up,both groups showed significant reduction in HbA1c[AITD group:8.40%(7.03%,10.78%)vs 7.65%(6.60%,8.93%),P<0.01;T1DM group:8.50%(7.20%,10.80%)vs 7.75%(6.70%,9.10%),P<0.01]and higher BMI,ln glucose disposal rate compared with baseline.However,between-groupdifferences were not significant(both P>0.05).After one-year follow-up,TSH level was still lower in hyperthyroidism group compared with normal thyroid function group[0.15(0.01,0.39)vs 1.92(1.34,3.17)nmol/L,P<0.05].Instead of the significant improvement on HbA1c level in hypothyroidism group and normal thyroid function group,there was no difference in hyperthyroidism group.Moreover,compared with normal thyroid function subgroup,there was significantly higher BMI[(22.37±2.89)vs(20.71±2.77)kg/m2,P<0.05]and systolic/diastolic blood pressure in hypothyroidism subgroup[systolic blood pressure:120(110,129)vs 111(103,122)mmHg;diastolic blood pressure:78(75,81)vs 70(63,77)mmHg,1 mmHg=0.133 kPa,both P<0.05].Conclusion Metabolic disorder w

关 键 词：糖尿病 1型 自身免疫性甲状腺疾病 

分 类 号：R581[医药卫生—内分泌] R587.2[医药卫生—内科学]