叶静文 邓嘉进 梁慰强 罗海钊 李惠贤 舒毅

【摘要】 目的：探討2型糖尿病患者合并亚临床甲状腺功能减退症（SCH）与糖尿病肾病、糖尿病视网膜病变的关系。方法：选取2018年1月-2019年10月本院收治的2型糖尿病患者646例，按甲状腺功能分为SCH组（n=47）与正常组（n=599）。分析两组临床资料，比较两组实验室指标、用药情况、糖尿病肾病与糖尿病视网膜病变的患病率。分析有无SCH与糖尿病微血管并发症的关系。结果：SCH组女性比例、促甲状腺激素（TSH）、服用非诺贝特的比例均高于正常组，而舒张压（DBP）、有吸烟史比例、肾小球滤过率（eGFR）均低于正常组（P<0.05）。SCH组尿微量白蛋白肌酐比（ACR）≥300 mg/g

比例高于正常组（P<0.05）。校正性别、年龄因素后，SCH为ACR≥300 mg/g的危险因素（OR=2.43，P=0.03）。结论：SCH与糖尿病肾病存在一定相关性，定期监测2型糖尿病患者甲状腺功能，及早发现SCH，可能会对预防及治疗糖尿病肾病有帮助。

【关键词】 2型糖尿病 亚临床甲状腺功能减退症 糖尿病微血管并发症

Association between Subclinical Hypothyroidism and Microvascular Complications in Type 2 Diabetic Patients/YE Jingwen， DENG Jiajin， LIANG Weiqiang， LUO Haizhao， LI Huixian， SHU Yi. //Medical Innovation of China， 2020， 17（11）： 056-060

[Abstract] Objective： To investigate the relationship between subclinical hypothyroidism （SCH） and diabetic nephropathy， diabetic retinopathy in type 2 diabetes patients. Method： A total of 646 patients with type 2 diabetes from January 2018 to October 2019 in our hospital were selected. According to thyroid function， they were divided into SCH group （n=47） and normal group （n=599）. Clinical data of the two groups were analyzed. The laboratory indicators， medication use， prevalence rates of diabetic nephropathy and diabetic retinopathy were compared between the two groups. The relationship between the presence or absence of SCH and diabetic microvascular complications was analyzed. Result： The proportion of females， thyrotropin （TSH） and take fenofibrate in the SCH group were higher than those of the normal group， while the diastolic blood pressure （DBP）， the proportion with smoking history and the glomerular filtration rate （eGFR） were lower than those of the normal group （P<0.05）. The proportion of urinary albuminto-ereatinine ratio （ACR）≥300 mg/g in the SCH group was higher than that in the normal group （P<0.05）. After adjusting for gender and age， SCH was a risk factor for ACR≥300 mg/g （OR=2.43， P=0.03）. Conclusion： There is a certain correlation between SCH and diabetic nephropathy， regular monitoring of thyroid function in patients with type 2 diabetes and early detection of SCH may be helpful for the prevention and treatment of diabetic nephropathy.

[Key words] Type 2 diabetes Subclinical hypothyroidism Diabetic microvascular complications

First-authors address： Affiliated Nanhai Hospital of Southern Medical University， Foshan 528000， China

doi：10.3969/j.issn.1674-4985.2020.11.014

亚临床甲状腺功能减退症（subclinical hypothyroidism，SCH）是指血清促甲状腺激素（TSH）水平升高，但甲状腺激素仍在正常范围内的病理状态。SCH与代谢综合征相关，2型糖尿病患者中SCH的患病率会高于一般人群[1-2]。在一项包括来自17项研究、7 378名糖尿病患者的荟萃分析中报道SCH的患病率为4.69%～18.86%[3-5]。虽然SCH通常无症状，但与高脂血症、动脉粥样硬化相关[6]。糖尿病肾病及糖尿病视网膜病变同属于糖尿病微血管并发症，关于SCH和糖尿病微血管并发症的关系报道不一[7-9]。本研究通过分析2型糖尿病合并SCH患者的临床资料，探讨SCH与糖尿病肾病、糖尿病视网膜病变的相关性，为2型糖尿病微血管并发症的防治提供参考，现报道如下。

1 资料与方法

1.1 一般资料 选取2018年1月-2019年10月本院收治的2型糖尿病患者646例，纳入标准：年龄18～90岁;均符合世界卫生组织1999年WHO糖尿病诊断标准。……