| Objective:To emphasize the importance and necessity of timely screening, diagnosis and treatment of subclinical hypothyroidism for diabetic patients by studying the impact of type 2 diabetic patients merging subclinical hypo thyroidism on the macrovascular and micro vascular lesions of diabetic.Methods:150 cases of type 2 diabetes mellitus (T2DM) patients were collected from June 2012 to September 2015 at the the Department of Endo-crinology of First Affiliated Hospital of Guangxi Medical University hospitalized. According to whether subclinical hypothyroidism disease,They are divided into two groups(controlled group and observed group), controlled group composed of 67 cases of simple type 2 diabetes mellitus, while observed group consist of 83 cases of type 2 diabetes mellitus patients with subclinical thyroid function hypothyroidism. Collected all enrolled inpatients clinical datas:gender, age (years), duration(years), smoking history (years), drinking history (years), blood pressure, BMI, fasting blood test for all patients with HbA1, GSP, TG, TC, LDL, HDL and apoAI, apoB, Hcy, Cystatin C, Uric Acid, TT3, TT4, FT3, FT4, TSH, TGAb, TMAb and TRAb, After controlling blood sugar steady and continuous stay two days in urine, measured 24 hours MAU, MAU≥30mg/24h is diabetic nephropathy, excluding other causes of kidney disease. All patients underwent fundus examination and fundus fluorescence angiography after dilation. underwent ECG or Hotter, MRI or CT, bilateral common carotid artery and lower extremity artery ultrasound to screen macrovascular disease. SPSS 16.0 statistical software was used to statistical alnalysis and chi-square test was used to compare rates.A multi factor of diabetic micro vascular lesions and large blood tube lesions were being correlation and regression analysis, P< 0.05 shown a statistically significant difference.Result:1. Compared the single factor of two groups,there was on analysis statistical difference (P> 0.05) between age, gender, duration, smoking history, BMI, SBP, DBP, HDL and apoAI, apoB, UA, GSP, TT3, TT4, FT3, FT4, yet TC, TG, LDL, Hcy, Cystatin C,24hMAU, TSH, TGAb, TMAb, TRAb showed statistically significant difference (P< 0.05).2. The incidence of retinopathy, nephropathy, coronary heart disease, carotid atherosclerosis of type 2 diabetes merging subclinical hypothyroidism is higher than that of the type 2 diabetes with normal thyroid function, respectively 46% vs 24%,44% vs 12%,21% vs 7%,41% vs 25%, were statistically significant differences(P<0.05),otherwise,cerebral infarction, lower extremity arterial sclerosis and diabetic foot sick rate did not show statistically difference(P>0.05).3. When controlling HBA1C, Age, Duration, SBP, TC, TG, there was a positive correlation between TSH and nephropathy, carotid artery atherosclerosis, lower extremity sclerosis, coronary heart disease, which showed statistically significant difference (P<0.05).The microvascular disease of Type 2 diabetes with sub clinical hypothyroidism have a positive correlation with Duration, SBP, TSH (P<0.05).the macrovascular disease was positively related to, Duration, SBP, UA, LDL, TSH (P<0.05).4. Binary logistic regression analysis showed that TSH, HBA1C, DBP, UA, Smoking history were the risk factors of macroangiopathy of diabetes merging subclinical hypothyroidism(P<0.05). Duration, TSH, SBP, UA were the risk factors of microangiopathy(P<0.05).Conclusion:1. The incidence of nephropathy, retinopathy, coronary heart disease and carotid atherosclerosis of type 2 diabetes merging subclinical hypothyroidism is higher than that of the type 2 diabetes with normal thyroid function.2.TSH was the independent factor associated with subclinical diabetic patients with vascular lesions.3. The impact factors of macroangiopathy of the type 2 diabetes merging subclinical hypothyroidism include of TSH, HBA1C, DBP, UA, Smoking history. While Duration, TSH, SBP, UA were the impact factors of microangiopathy incorporate. |
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