摘要
目的探讨甲状腺功能正常的2型糖尿病(T2DM)患者血清甲状腺激素(TH)水平与糖尿病视网膜病变(DR)的关系。方法回顾分析2019年6月至2020年8月住院治疗的T2DM患者785例,分为DR组(n=119)和非DR组(NDR组,n=666)。将其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)、FT3/FT4从低到高进行五分位分组(Q1、Q2、Q3、Q4、Q5),比较不同甲状腺激素水平对DR患病率的影响。将样本人群的糖化血红蛋白(HbA1c)分为A组(<7.0%)和B组(≥7.0%),比较2组间FT3、FT4、TSH水平以及FT3/FT4。结果DR组患者的年龄、糖尿病病程、胱抑素-C、尿微量白蛋白与尿肌酐比值(UACR)明显高于NDR组,差异有统计学意义(P<0.05);DR组的空腹C肽、FT3水平、FT3/FT4、eGFR明显低于NDR组,差异有统计学意义(P<0.05)。FT3-Q1组的DR患病率明显高于Q2-Q5组,差异均有统计学意义(P<0.05),而将FT3-Q2-Q5的DR患病率两两间比较,差异无统计学意义(P>0.05)。比较HbA1c的A、B2组的FT3、FT4、TSH水平以及FT3/FT4,发现A组的FT3、FT4、FT3/FT4水平较B组的高,差异均有统计学意义(P<0.05),而2组间的TSH差异无统计学意义(P>0.05)。Logistic回归分析显示:DM病程≥10年(OR=2.945,95%CI:2.252~3.851,P=0.000)、HbA1c≥7.0%(OR=1.458,95%CI:1.091~1.949,P=0.011)、FT3<2.36 pg/ml(OR=1.905,95%CI:1.197~3.031,P=0.005)均为DR的独立危险因素。结论低FT3是甲功正常的T2DM患者DR的危险因素之一;更好的HbA1c控制可以带来较高的FT3水平,从而减少DR的发生。
Objective To explore the correlation between serum thyroid hormone(TH)levels and diabetes retinopathy(DR)in euthyroid type 2 diabetes mellitus(T2DM)patients.Methods From June 2019 to August 2020,785 T2DM inpatients were retrospectively analyzed.They were divided into DR group(n=119)and non-DR group(NDR group,n=666).Patients were further subgrouped by the quintile rankings of free triiodothyrosine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)and FT3/FT4 from low to high(Q1,Q2,Q3,Q4 and Q5),and thus the influence of different thyroid hormone levels on the prevalence of DR was analyzed.Later,patients were divided into group A(<7.0%)and group B(≥7.0%)based on the glycosylated hemoglobin A1c(HbA1c)level,and FT3,FT4,TSH and FT3/FT4 were compared between the two groups.Results The age,duration of diabetes,Cystatin C,and urine albumin-to-creatinine ratio(UACR)in DR group were significantly higher than those in NDR group(P<0.05).Fasting C-peptide(FC-P),FT3,FT3/FT4 and estimated glomerular filtration rate(eGFR)in DR group were significantly lower than those in NDR group(P<0.05).The prevalence of DR in FT3-Q1 was significantly higher than that in Q2-Q5 groups(P<0.05),which was comparable among the latter four groups(P>0.05).FT3,FT4 level and FT3/FT4 in group A were significantly higher than those in group B(P<0.05),while the TSH level between the two groups was comparable(P>0.05).Logistic regression analysis showed that duration of DM≥10 years(OR=2.945,95%CI:2.252-3.851,P=0.000),HbA1c≥7.0%(OR=1.458,95%CI:1.091-1.949,P=0.011)and FT3<2.36 pg/ml(OR=1.905,95%CI:1.197-3.031,P=0.005)were independent risk factors for DR.Conclusion Low FT3 is one of the risk factors for DR in euthyroid T2DM patients.A better control of HbA1c contributes to reduce the occurrence of DR by increasing FT3.
作者
程磊磊
刘博伟
孙丽娜
刘俊茹
范冬梅
尹福在
CHENG Leilei;LIU Bowei;SUN Lina(Chengde Medical University,Hebei,Chengde 067000,China;不详)
出处
《河北医药》
CAS
2023年第8期1179-1182,1186,共5页
Hebei Medical Journal
