| Objective By investigating the prognosis of elderly patients with T2 DM,the relationship between the main causes of death and clinical indicators in elderly T2 DM patients was analyzed,and the effects of FT3,FT4 and TSH on the prognosis of elderly T2 DM were investigated.Methods 362 elderly subjects with T2 DM were selected from patients in General Hospital of the Ministry of Health and Medical Tianjin Medical University during January 2018 to December 2018,including 249 improved and 113 died.These patients have to undergo OGTT and related examination and medical history confirmed T2 DM,excluding groups of type 1 diabetes,IGT,IFG,acute complications of diabetes.The subjects had no pituitary or hypothalamic diseases that may cause abnormal TH levels,and no major surgery,trauma,severe infections and other stress conditions in recent years.And these subjects accepted FPG,Hb A1 c,FT3,FT4,TSH and other inspections.First,the medical records of dead elderly T2 DM patients were analyzed,and the main causes of death were investigated.Then,the relationship between the thyroid hormone levels(FT3,FT4,and TSH)and prognosis was explored by logistic regression analysis.The thyroid hormone levels(FT3,FT4,and TSH)and death rate were used as the independent variables and the dependent variable,respectively.Results 1.The subjects were divided into two groups,i.e.,the death group and the improved group.There were no significant difference between the gender,drinking history,DBP and FPG of the patients from the two groups(P>0.05).However,age,smoking history,duration of disease,P,SBP,TC,TG,LDL-C,Scr,UA,TSH in the death group were significantly higher than those in the improved group(P<0.01);the prevalence of CHD,HBP,CD,HF and CKD in the death group was significantly higher than that in the improved group(P<0.01);Hb Alc in the death group was significantly higher than that in the improved group,and the difference was statistically significant(P<0.05);HGB,HDL-C,TP,ALB,FT3 and FT4 in the death group were significantly lower than those in the improved group,and the difference was statistically significant(P<0.01).2.According to the cause of death,the composition ratio is sorted from large to small,and the top 5 were: CVD 46 cases(40.7%),infectious diseases 23 cases(20.4%),malignant tumors 17 cases(15%),CD 8 cases(7.1%),DN 6 cases(5.3%).3.Among the 362 elderly subjects with T2 DM,there are 261 cases of normal thyroid function(72.1%),and 101 cases of thyroid dysfunction(27.9%),including 61 cases of SCH(16.9%),20 cases of hypothyroidism(5.5%),10 cases of subclinical hyperthyroidism(2.8%),2 cases of hyperthyroidism(0.6%),8 cases of low T3 syndrome(2.2%).In the improved group(249 cases),there are 215 cases of normal thyroid function(86.3%),34 cases of thyroid dysfunction(13.7%),including 24 cases of SCH(9.7%),8 cases of subclinical hyperthyroidism(3.2%),2 cases of hyperthyroidism(0.8%);while in the death group(113 cases),there are 46 cases of normal thyroid function(40.7%),67 cases of thyroid dysfunction(59.3%),including 37 cases of SCH(32.7%),20 cases of hypothyroidism(17.7%),2 cases of subclinical hyperthyroidism(1.8%),8 cases of low T3 syndrome(7.1%).4.TSH of female was higher than that of male,and the difference was statistically significant(P<0.01);while there was no difference in FT3 and FT4 between different genders(P>0.05).5.FT3 was negatively correlated with duration of DM(r=-0.265,P<0.01),and FT4 was negatively correlated with duration of DM(r=-0.126,P<0.05);while TSH was positively correlated with duration of DM(r=0.5229,P<0.01).6.According to the level of Hb A1 C,the patients were divided into three groups,namely,the group with Hb A1C≤7%,7%<Hb A1C<10% group,and Hb A1C≥10% group.With the increase of Hb A1 C,FT3 gradually increased,and there was statistical significance in Hb A1C≤7% group and 7%<Hb A1C<10% group(P<0.05);with the increase of Hb A1 C,FT3 gradually decreased,and there was statistical significance in the group of 7%<Hb A1C<10% and Hb A1C≥10%(P<0.01);with the increase of Hb A1 C,TSH gradually decreased,and there was statistical significance in Hb A1C≤7%group and 7%<Hb A1C<10% group(P<0.01);with the increase of Hb A1 C,TSH gradually increased,and there was statistical significance in Hb A1C≤7% group and Hb A1C≥10% group(P<0.01);there was no difference in FT4(P>0.05).7.Whether death is the dependent variable and FT3 as the independent variable to conduct two-class logistic regression analysis,shows that FT3 is a protective factor for elderly patients with T2DM(β=-1.878<0,OR=0.153<1),namely the lower the FT3 the higher the risk of death in elderly T2 DM patients,the difference was statistically significant(P<0.01).8.Whether death is the dependent variable and FT4 as the independent variable to conduct two-class logistic regression analysis,shows that FT4 is a protective factor for elderly patients with T2DM(β=-0.278<0,OR=0.758<1),namely the lower the FT4 the higher the risk of death in elderly T2 DM patients,the difference was statistically significant(P<0.01).9.Whether death is the dependent variable and TSH as the independent variable to conduct two-class logistic regression analysis,shows that TSH is a risk factor for elderly patients with T2DM(β=0.716>0,OR=2.046>1),namely the higher the TSH the higher the risk of death in elderly T2 DM patients,the difference was statistically significant(P<0.01).10.Whether death is the dependent variable and FT3,FT4,TSH as the independent variable to conduct two-class logistic regression analysis,correction of age,smoking history,duration of DM,P,SBP,HGB,TC,TG,HDL-C,LDL-C,TP,ALB,Scr,UA,Hb A1 c,CHD,HBP,CD,HF,CKD,shows that FT3 is a protective factor for elderly patients with T2DM(β=-4.302<0,OR=0.014<1),namely the lower the FT3 the higher the risk of death in elderly T2 DM patients,the difference was statistically significant(P<0.01),FT4 and TSH were not associated with the prognosis of elderly T2DM(P>0.05).Conclusion CVD is the leading cause of death in elderly patients with T2 DM,but FT3 is a protective factor for elderly patients with T2 DM.FT4 and TSH have no relationship with the prognosis of elderly T2 DM patients. |
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