上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (9): 1066-.doi: 10.3969/j.issn.1674-8115.2018.09.011

• 论著·临床研究 • 上一篇    下一篇

社区 2型糖尿病患者甲状腺结节危险因素研究分析

金志萍 1，张珊 2，于雪梅 2，陈海冰 3，胡承 3   

  1. 1.上海市奉贤区南桥镇社区卫生服务中心，上海 201499；2.上海交通大学附属第六人民医院南院内分泌代谢科，上海 201499；3.上海交通大学附属第六人民医院内分泌代谢科，上海市糖尿病研究所，上海 200233
  • 出版日期:2018-09-28 发布日期:2018-10-15
  • 通讯作者: 胡承，电子信箱：alfredhc@sjtu.edu.cn。
  • 作者简介:金志萍（1973—），女，副主任医师，硕士生；电子信箱： zipingjin@126.com。
  • 基金资助:
    上海市教育委员会高峰高原学科建设计划（20152527）；上海市奉贤区社会类（卫生）科技发展基金项目（奉科 20151214）

Analysis of risk factors of thyroid nodules in patients with type 2 diabetes in the community

JIN Zhi-ping1, ZHANG Shan2, YU Xue-mei2, CHEN Hai-bing3, HU Cheng3   

  1. 1. Nanqiao Town Community Health Service Center, Fengxian District, Shanghai 201499, China; 2. Department of Endocrinology and Metabolism, South Branch of Shanghai Sixth Peoples Hospital, Shanghai Jiao Tong University, Shanghai 201499, China; 3. Department of Endocrinology and Metabolism, Shanghai Sixth Peoples Hospital, Shanghai Jiao Tong University, Shanghai Diabetes Institute, Shanghai 200233, China
  • Online:2018-09-28 Published:2018-10-15
  • Supported by:
    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Support，20152527; Shanghai Fengxian District Health Technology Development Fund Project, 20151214

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摘要： 目的 ·评估社区 2型糖尿病（ type 2 diabetes mellitus，T2DM）患者甲状腺结节的患病情况、危险因素以及糖尿病大血管病变对其发病的影响。方法 ·选取 2015年 3月至 2017年 12月在社区家庭医生门诊及奉贤区中心医院内分泌科就诊的 T2DM患者 711例，收集人体测量学资料和临床检测数据；根据甲状腺超声结果进行诊断，分为有甲状腺结节组和无甲状腺结节组；采用 Logistic回归分析患者年龄、性别、体质量指数、糖脂代谢指标、胰岛功能指标、甲状腺功能指标与甲状腺结节的关联强度，分析可能导致 T2DM患者发生甲状腺结节的危险因素，并进一步分析 T2DM大血管病变对甲状腺结节发病的影响。结果 · 711例 T2DM患者中有甲状腺结节的患者 438例（61.60%），其中男性 231例（占男性人群的 55.13%），女性 207例（占女性人群的 70.89%)。在对有无甲状腺结节的 2组人群进行人体测量学资料、糖脂代谢指标、胰岛功能指标、甲状腺功能指标的比较发现：性别，年龄，病程，及餐后 2 h血糖、总胆固醇、三酰甘油、低密度脂蛋白、游离三碘甲状腺原氨酸、甲状腺过氧化物酶抗体水平在 2组间的差异均有统计学意义（ P<0.05）。多因素 Logistic回归分析结果显示：女性，年龄增加，及餐后 2 h血糖、低密度脂蛋白、甲状腺球蛋白抗体的减少是 T2DM甲状腺结节发生的危险因素（ P<0.05）；在校正这些危险因素后发现， T2DM合并大血管病变与甲状腺结节的发生无明显相关性（ P>0.05）。结论 ·女性，高龄，及餐后 2 h血糖、低密度脂蛋白、甲状腺球蛋白抗体的减少是社区 T2DM患者甲状腺结节发生的危险因素；尚无证据表明 T2DM患者合并大血管并发症与甲状腺结节的发生存在相关性。

关键词: 2型糖尿病, 甲状腺结节, 危险因素, 糖尿病大血管病变

Abstract:

Objective · To evaluate the prevalence, risk factors and the effects of macrovascular complications on the onset of thyroid nodules in patients with type 2 diabetes mellitus (T2DM) in the community. Methods · A total of 711 outpatients with T2DM March 2015 to December 2017 in Community Family Doctor Outpatient Department and Department of Endocrinology and Metabolism of Fengxian District Central Hospital were selected. Anthropometric data and clinical test data were collected. Patients were divided into two groups based on the results of thyroid ultrasound. The Logistic regression analysis was used to analyze the risk factors for thyroid nodules in T2DM patients, such as age, sex, body mass index, glycolipid metabolism index, pancreatic function index, and thyroid function index. Furthermore, the effect of macrovascular disease on the onset of thyroid nodules was analyzed. Results · Of the 711 patients with T2DM, 438 (61.60%) had thyroid nodules, including 231 males (55.13% of the male population) and 207 females (70.89% of the female population). Comparison of anthropometry data, glycolipid metabolism index, pancreatic function index, and thyroid function index in groups with and without thyroid nodules revealed that there was a statistically significant difference in gender, age, duration of T2DM, 2-hour post-meal plasma glucose, total cholesterol, triglyceride, low density lipoprotein-cholesterol, free triiodothyronine, and thyroid peroxidase antibody between the two groups (P<0.05). Multivariate Logistic regression analysis showed that gender, age, 2-hour post-meal plasma glucose, low density lipoprotein-cholesterol, and thyroglobulin antibodies levels were the risk factors of thyroid nodules in T2DM patients (P<0.05). After adjusting for these risk factors, it was found that there was no significant correlation between macrovascular complication and thyroid nodules in T2DM patients (P>0.05). Conclusion · This study found that females, seniors, reduction of 2-hour post-meal plasma glucose, low density lipoprotein-cholesterol, and thyroglobulin antibody levels were the risk factors of thyroid nodules in T2DM patients in the community. There is no certain correlation between macrovascular complications and the occurrence of thyroid nodules in T2DM.

Key words: type 2 diabetes , thyroid nodule, risk factors, macrovascular complications

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