老年2型糖尿病住院患者甲状腺功能异常及其影响因素的临床分析

Thyroid dysfunction and influencing factors in elderly hospitalized patients with type 2 diabetes mellitus

摘要:

目的 观察和分析老年2型糖尿病（T2DM）住院患者甲状腺功能异常及其影响因素。方法 对2014年10月至2015年5月在中日友好医院内分泌科住院的190例既往无甲状腺病史、年龄≥60岁的老年T2DM患者的甲状腺功能状况和相关临床指标进行调查和分析。结果 （1）在190例患者中，甲状腺功能异常比例为38.4%（73例），其中低T3综合征为22.1%（42例），原发性甲状腺功能减退症（甲减）为15.8%（30例）。（2）3组人群相比较，低T3综合征组糖化血红蛋白（HbAlc）明显高于其他两组，年龄、病程大于甲状腺功能正常组；甲减组甲状腺过氧化物酶抗体（TPOAb）和（或）甲状腺球蛋白抗体（TGAb）阳性率为最高，达到70%（均P＜0.05）。（3）3组血清25羟维生素D（25-OH-vit D）水平均处于缺乏状态。（4）logistic回归分析显示年龄与低T3综合征发生呈正相关（OR＝2.77，P＝0.012）；TPOAb（OR＝4.13，P＝0.026）、TGAb（OR＝3.57，P＝0.026）与甲减发生呈正相关。结论 老年T2DM住院患者甲状腺功能异常发生率较高，存在自身免疫因素易发生甲减；高龄患者更易发生低T3综合征；未看到维生素D缺乏在各组患者中的差异。

Abstract:

Objective To observe the incidence of thyroid dysfunction in the elderly patients with type 2 diabetes mellitus (T2DM) and investigate the influencing factors. Methods A total of 190 T2DM patients (over 60 years old) without history of thyroid diseases hospitalized in our department from October 2014 to May 2015 were enrolled in this study. Their clinical and pathological data were retrospectively reviewed and analyzed. Results (1) The incidence of thyroid dysfunction was 38.4% (73/190), including 22.1% (42 cases) of low T3 syndrome and 15.8% (30 cases) of idiopathic hypothyroidism. (2) The patients with low T3 syndrome had higher level of HbA1c, older age and longer T2DM duration when compared to idiopathic hypothyroidism group and those without thyroid dysfunction (P＜0.05). The positive percentages of thyroglobulin antibody (TGAb) and/or thyroid peroxidase antibody (TPOAb) were obviously higher (70%) in hypothyroidism group (P＜0.05). (3) The 25-hydroxy vitamin D (25-OH-vit D) level was deficient among the 3 groups. (4) Logistic regression analysis showed that age was positively correlated with the incidence of low T3 syndrome (OR＝2.77, P＝0.012), and the levels of TGAb (OR＝3.57, P＝0.026) and TPOAb (OR＝4.13, P＝0.026) were respectively correlated with hypothyroidism. Conclusion Thyroid dysfunction is quite common in the elderly with T2DM, and their autoimmune background may induce hypothyroidism. Elderly patients are more likely to suffer from low T3 syndrome. But there is no difference in vitamin D deficiency among those without thyroid dysfunction, hypothyroidism and low T3 syndrome.