本文關(guān)鍵詞：亞臨床甲減與2型糖尿病患者頸動(dòng)脈粥樣硬化和糖尿病腎臟病的相關(guān)性研究　出處：《山西醫(yī)科大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 2型糖尿病 亞臨床甲狀腺功能減退 頸動(dòng)脈粥樣硬化 糖尿病腎臟病

【摘要】：目的:本研究旨在分析亞臨床甲狀腺功能減退與2型糖尿病患者頸動(dòng)脈粥樣硬化和糖尿病腎臟病的相關(guān)性,從而探討亞臨床甲狀腺功能減退對(duì)2型糖尿病患者血管并發(fā)癥的影響。方法:連續(xù)收集2015年8月至2015年12月間于山西醫(yī)科大學(xué)第一醫(yī)院內(nèi)分泌科住院的T2DM患者310例進(jìn)行橫斷面研究,其中男性182例,女性128例,平均年齡(59.1±8.8)歲,平均糖尿病病程(9.8±6.6)年,平均體重指數(shù)(BMI)(24.77±2.92)kg/m2。所有患者均符合1999年WHO糖尿病診斷分型標(biāo)準(zhǔn)。排除標(biāo)準(zhǔn):合并有糖尿病急性并發(fā)癥、感染、妊娠、嚴(yán)重的心肝腎功能不全、惡性腫瘤者,以及既往有甲狀腺疾病史,或使用對(duì)甲狀腺功能有影響的藥物者。采集患者的一般資料包括:年齡、性別、糖尿病病程、既往史、吸煙史、記錄入院時(shí)血壓、身高、體重,計(jì)算BMI。身高測(cè)定:被測(cè)者脫去身上較重的衣物、鞋、包等,赤腳以立正姿勢(shì)站于標(biāo)準(zhǔn)體重計(jì)的中部,頭擺正,眼睛平視前方,測(cè)量精確到0.01m。體重測(cè)定:被測(cè)者空腹,脫去身上較重的衣物、鞋、包等,身上僅留單衣,赤腳站于標(biāo)準(zhǔn)體重計(jì)的中部,測(cè)量精確到0.1kg。血壓測(cè)量:所有患者均于安靜的環(huán)境中至少休息30分鐘(期間禁止抽煙,喝酒,飲用咖啡、茶等飲料),然后用標(biāo)準(zhǔn)水銀血壓計(jì)按照袖帶加壓法于右上臂進(jìn)行測(cè)量,每人最少測(cè)量2次(中間需相隔3分鐘),最后取其平均值作為血壓的測(cè)定值。全部患者均于入院后次日清晨空腹8-12小時(shí)后留取肘靜脈血,檢測(cè)指標(biāo)包括:游離三碘甲狀原氨酸(FT3)、游離甲狀腺素(FT4)、促甲狀腺素(TSH)、空腹血糖(FPG)、糖化血紅蛋白(hba1c)、總膽固醇(tc)、甘油三酯(tg)、血肌酐(scr)、高密度脂蛋白膽固醇(hdl-c)、低密度脂蛋白膽固醇(ldl-c)、超敏c反應(yīng)蛋白(hs-crp)、血清天門(mén)冬氨酸氨基轉(zhuǎn)移酶(ast)、血清丙氨酸氨基轉(zhuǎn)移酶(alt)。同時(shí)留取晨尿檢測(cè)尿微量白蛋白和尿肌酐,計(jì)算尿微量白蛋白和尿肌酐的比值(uacr)。依據(jù)scr值計(jì)算腎小球?yàn)V過(guò)率(egfr),采用適于中國(guó)人的改良mdrd公式,egfr[ml/(min·1.73m2)]=175×scr-1.234×年齡-0.179(如果是女性×0.79)。所有患者行頸動(dòng)脈彩超檢查來(lái)獲得內(nèi)膜中層厚度(imt)和有無(wú)斑塊的形成,將imt≥1.0mm或合并有明顯斑塊者定義為頸動(dòng)脈粥樣硬化(cas),imt1.0mm以及管壁光滑者定義為無(wú)cas。依據(jù)《糖尿病腎病防治專(zhuān)家共識(shí)》(2014版)將uacr≥30mg/g或有糖尿病視網(wǎng)膜病合并egfr異常者(egfr90ml/(min·1.73m2))視為糖尿病腎臟病(dkd)。亞臨床甲狀腺功能減退(sch)參照《成人甲狀腺功能減退治療指南》(2012版)的診斷標(biāo)準(zhǔn):血清tsh水平高于正常值上限,血清ft3、ft4在正常范圍。結(jié)合本院甲功的參考范圍,以tsh4.2uiu/ml為sch診斷切點(diǎn),即tsh≥4.2uiu/ml,且ft3、ft4正常者診斷sch。依據(jù)甲狀腺功能將患者分為2組:單純t2dm組、t2dm合并sch組。比較兩組cas和dkd的差異。logistic回歸分析探討sch與cas和dkd的關(guān)系。所有數(shù)據(jù)用spss20.0統(tǒng)計(jì)軟件進(jìn)行分析,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,對(duì)數(shù)據(jù)進(jìn)行正態(tài)性檢驗(yàn),偏態(tài)分布計(jì)量資料如tsh、fpg、tg、tc等應(yīng)用自然對(duì)數(shù)轉(zhuǎn)換后再分析,組間比較采用t檢驗(yàn)。計(jì)數(shù)資料以百分率表示,組間比較采用卡方檢驗(yàn)。危險(xiǎn)因素分析采用logistic回歸分析。p0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.t2dm合并sch組與單純t2dm組的臨床參數(shù)比較:與單純t2dm組相比,t2dm合并sch組的hs-crp水平高、tc水平高、tg水平高,差異有統(tǒng)計(jì)學(xué)意義(p0.05);兩組性別、年齡、bmi、糖尿病病程、高血壓病史、吸煙、sbp、dbp、fpg、hba1c、hdl-c、ldl-c相比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。2.t2dm合并sch組與單純t2dm組cas和dkd發(fā)生率的比較:t2dm合并sch組cas和dkd發(fā)生率均高于單純t2dm組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。3.T2DM患者CAS的logistic回歸分析:3.1單因素logistic回歸分析:以有無(wú)CAS為因變量,分別以有無(wú)SCH、性別、年齡、糖尿病病程、有無(wú)高血壓、是否吸煙、SBP、DBP、FPG、HbA1c、TC、TG、HDL-C、LDL-C為自變量做單因素logistic回歸分析,結(jié)果顯示:SCH(OR值為2.214,P0.05)、高血壓(OR值為2.451,P0.05)、年齡(OR值為1.062,P0.05)、糖尿病病程(OR值為1.054,P0.05)、TC(OR值為1.079,P0.05)與CAS相關(guān)。3.2多因素logistic回歸分析:以有無(wú)CAS為因變量,以單因素分析篩選出的和臨床中有共識(shí)的指標(biāo)為自變量做多因素logistic回歸分析,結(jié)果顯示:在調(diào)整年齡、性別、糖尿病病程、BMI、高血壓、吸煙、TC后,SCH與CAS相關(guān)(OR值為2.364,P0.05),SCH患者發(fā)生CAS的風(fēng)險(xiǎn)是無(wú)SCH患者的2.364倍。4.T2DM患者DKD的logistic回歸分析:4.1單因素logistic回歸分析:以有無(wú)DKD為因變量,分別以有無(wú)SCH、性別、年齡、糖尿病病程、有無(wú)高血壓、是否吸煙、SBP、DBP、FPG、HbA1c、TC、TG、HDL-C、LDL-C為自變量做單因素logistic回歸分析,結(jié)果顯示:SCH(OR值為1.849,P0.05)、高血壓(OR值為2.091,P0.05)、SBP(OR值為1.028,P0.05)、HbA1c(OR值為1.272,P0.05)、TG(OR值為1.350,P0.05)與DKD相關(guān)。4.2多因素logistic回歸分析:以有無(wú)DKD為因變量,以單因素分析篩選出的和臨床中有共識(shí)的指標(biāo)為自變量做多因素logistic回歸分析,結(jié)果顯示:在調(diào)整性別、年齡、糖尿病病程、高血壓、BMI、SBP、HbA1c、TG后,SCH與DKD相關(guān)(OR值為2.053,P0.05),SCH患者發(fā)生DKD的風(fēng)險(xiǎn)是無(wú)SCH患者的2.053倍。結(jié)論:1.2型糖尿病合并亞臨床甲減者頸動(dòng)脈粥樣硬化的發(fā)生率增高,亞臨床甲減可能會(huì)增加2型糖尿病患者頸動(dòng)脈粥樣硬化的發(fā)生風(fēng)險(xiǎn)。2.2型糖尿病合并亞臨床甲減者糖尿病腎臟病的發(fā)生率增高,亞臨床甲減可能會(huì)增加2型糖尿病患者糖尿病腎臟病的發(fā)生風(fēng)險(xiǎn)。
[Abstract]:Objective: the purpose of this study is to analyze the correlation between subclinical hypothyroidism and carotid atherosclerosis and diabetic nephropathy in type 2 diabetic patients, so as to explore the effect of subclinical hypothyroidism on vascular complications in patients with type 2 diabetes. Methods: from August 2015 to December 2015 in 310 cases of T2DM patients hospitalized in the Department of Endocrinology, the first hospital of Shanxi Medical University were investigated, of which 182 were male, 128 were female, the average age (59.1 + 8.8) years old, the average duration of diabetes (9.8 + 6.6) years, the average body mass index (BMI) (24.77 + 2.92) kg/m2. All patients were in accordance with the diagnostic criteria for WHO diabetes in 1999. Exclusion criteria: those with diabetes, acute complications, infection, pregnancy, severe heart, liver and kidney dysfunction, malignant tumor, and past history of thyroid disease, or those who have influence on thyroid function. The general data of the patients included age, sex, course of diabetes, history, history of smoking, history of smoking, blood pressure, height, weight, and BMI. Height determination: measured by removing his heavy clothing, shoes, bags, barefoot in the central station to stand at attention posture, the standard weight of head upright, eyes straight ahead, accurate to 0.01m. Weight determination: measured fasting, removing his heavy clothing, shoes, bags and other body, leaving only unlined, standing barefoot in the central standard weight measurement, accurate to 0.1kg. Blood pressure measurement: all the patients were in a quiet environment to rest for at least 30 minutes (smoke, drink alcohol during prohibition, drinking coffee, tea and other drinks), and then use the standard mercury sphygmomanometer cuff compression method according to the measurement in the right arm, each at least 2 measurements (which requires 3 minutes apart), finally take the average as the blood pressure measurement. All patients were admitted to hospital after fasting for 8-12 hours after leaving the umbilical venous blood, the indexes included: free three iodine thyroid original acid (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), serum creatinine (SCR), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), high sensitive C reactive protein (hs-CRP), serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT). The urine microalbuminuria and urinary creatinine were measured at the same time, and the ratio of urine microalbuminuria and urine creatinine (UACR) was calculated. According to the SCR value, we calculated glomerular filtration rate (EGFR) and adopted the modified MDRD formula suitable for Chinese people, egfr[ml/ (min. 1.73m2)]=175 * scr-1.234 * age -0.179 (if female X 0.79). All patients underwent carotid artery ultrasonography to obtain the intima-media thickness (IMT) and plaque formation, IMT = 1.0mm or with obvious plaque were defined as carotid atherosclerosis (CAS), imt1.0mm and the smooth tube wall is defined as cas. On the basis of "expert consensus" prevention and treatment of diabetic nephropathy (2014 Edition) UACR = 30mg/g or diabetic retinopathy with abnormal EGFR (egfr90ml/ (min, 1.73m2)) as diabetic kidney disease (DKD). Subclinical hypothyroidism (SCH) is based on the diagnostic criteria of the treatment guidelines for adult hypothyroidism (2012 Edition): serum TSH level is higher than the upper limit of normal value, serum FT3 and FT4 are in normal range. With the reference range of thyroid function in our hospital, to tsh4.2uiu/ml for the diagnosis of SCH sites, TSH is more than 4.2uiu/ml, FT3, FT4 and sch of normal diagnosis. According to the thyroid function, the patients were divided into 2 groups: simple T2DM group, T2DM combined with Sch group. The differences between the two groups of CAS and DKD were compared. Logistic regression analysis was used to investigate the relationship between Sch and CAS and DKD. All data were analyzed by spss20.0 statistical software. The data were represented by mean + standard deviation (x + s). The normality of data was tested, and the skewed distribution data such as TSH, FPG, TG and TC were re analyzed after natural logarithmic transformation. T test was used in comparison between groups. The count data were expressed as a percentage, and the chi square test was used among the groups. Logistic regression analysis was used for the analysis of risk factors. P0.05 indicated that the difference was statistically significant. Results: compare the clinical parameters of 1.t2dm combined with Sch group and T2DM group: compared with T2DM group, T2DM Sch group with high hs-CRP level, high Tc level, TG level is high, the difference was statistically significant (P0.05); the two groups of gender, age, BMI, duration of diabetes, hypertension, smoking history, SBP FPG, HbA1c, DBP, HDL-C, and LDL-C, the difference was not statistically significant (P0.05). The incidence of CAS and DKD in group 2.t2dm combined with Sch and T2DM alone: the incidence of CAS and DKD in T2DM plus Sch group were all higher than those in simple T2DM group, the difference was statistically significant (P0.05). Patients with 3.T2DM CAS logistic regression analysis: 3.1 single factor Logistic regression analysis: the CAS as the dependent variable, respectively, with no SCH, gender, age, duration of diabetes, hypertension, smoking, no SBP, DBP, FPG, HbA1c, TC, TG, HDL-C and LDL-C as independent variables to do single factor Logistic regression analysis results showed that: SCH (OR = 2.214, P0.05), hypertension (OR = 2.451, P0.05), age (OR = 1.062, P0.05), diabetes (OR = 1.054, P0.05), TC (OR = 1.079, P0.05) and CAS. Logistic 3.2 multi factor regression analysis: with or without CAS as the dependent variable, using single factor analysis results are consensus screened and clinical index for logistic independent multi factor regression analysis showed that after adjusting for age, sex, duration of diabetes, hypertension, smoking, BMI, TC, SCH and CAS (OR = 2.364, P0.05), risk of patients with SCH CAS is 2.364 times higher than in patients without SCH. Logistic regression analysis of DKD in patients with 4.T2DM: 4.1 univariate logistic regression analysis: whether DKD was the dependent variable, whether there were SCH, gender, age, duration of diabetes, hypertension, smoking, SBP, D.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R587.2;R581.2

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2 特約記者 魯海燕;逾八成公眾存在糖尿病高危因素[N];家庭醫(yī)生報(bào);2013年

3 馬明愈;現(xiàn)代生活方式導(dǎo)致 糖尿病發(fā)病率迅速上升[N];中國(guó)婦女報(bào);2005年

4 省立醫(yī)院內(nèi)分泌科主任醫(yī)師 侯建明;糖尿病腎病的防治[N];福建科技報(bào);2004年

5 王文絹 范軍星;世界糖尿病日關(guān)注焦點(diǎn):糖尿病并發(fā)癥[N];健康報(bào);2003年

6 主持人 向紅丁博士;糖尿病腎病須早防早治[N];人民政協(xié)報(bào);2002年

7 華悅;預(yù)防糖尿病，從減肥開(kāi)始[N];上海中醫(yī)藥報(bào);2004年

8 劉冬梅;肥胖糖尿病第一誘因[N];天津日?qǐng)?bào);2004年

9 劉燕玲;首部中醫(yī)專(zhuān)病指南定下糖尿病治則[N];健康報(bào);2007年

10 崔昕;中藥防治糖尿病腎病有進(jìn)展[N];健康時(shí)報(bào);2006年

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1 王曉杰;組蛋白去乙酰化酶4特異性促進(jìn)糖尿病腎病足細(xì)胞損傷[D];山東大學(xué);2015年

2 張永;MiR-346在抗TGF-β信號(hào)途徑介導(dǎo)的糖尿病腎病發(fā)生和發(fā)展中的作用機(jī)制[D];武漢大學(xué);2015年

3 魏鳳江;高尿酸血癥、2型糖尿病及糖尿病微血管病變的群體遺傳學(xué)研究[D];天津醫(yī)科大學(xué);2015年

4 孫士杰;胱抑素C對(duì)2型糖尿病視網(wǎng)膜病變預(yù)測(cè)價(jià)值研究[D];山東大學(xué);2015年

5 魏艷紅;PKCα介導(dǎo)的EGFR降解在糖尿病腎病足細(xì)胞損傷中的作用及機(jī)制[D];華中科技大學(xué);2015年

6 龍泓竹;益氣養(yǎng)陰通絡(luò)散結(jié)方防治早期糖尿病腎病的臨床及實(shí)驗(yàn)研究[D];北京中醫(yī)藥大學(xué);2016年

7 姜e，

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