糖尿病患者合并甲状腺功能障碍84例临床分析

在同一个体或家庭中糖尿病与自身免疫性甲状腺疾病会同时存在,两者同属内分泌系统疾病,多存在自身免疫功能异常.通常自身免疫性甲状腺疾病在女性和高龄人群发病率较高,甲状腺功能异常引起代谢紊乱从而影响1型糖尿病.合并有自身免疫性甲状腺疾病的糖尿病患者病情会加重'<[1]>.国内对这两种疾病合并发生也有关注,但多是针对病例的报道'<2-4>.本研究通过比较正常人群与糖尿病患者中甲状腺疾病的发病情况,以期了解1型糖尿病与甲状腺疾病的关系.     

1255例住院2型糖尿病患者甲状腺疾病患病率分析

目的探讨北京丰台地区住院2型糖尿病患者中甲状腺疾病的流行现状。方法回顾性分析2005年6月～2010年6月我院内分泌科住院治疗的1255例2型糖尿病患者的甲状腺功能状况。结果（1）2型糖尿病患者合并甲状腺疾病的患病率为11．00％,甲状腺功能减退与甲状腺功能亢进的患病率比较差异无统计学意义;（2）2型糖尿病患者中,女性甲状腺疾病患病率为15．32％,男性甲状腺疾病患病率为7．42％,两者比较差异有统计学意义（P〈0．05）;（3）2型糖尿病患者中,甲状腺功能减退的患病率随年龄的增加而增加（P〈0．05）,亚临床甲状腺功能减退的患病率随病程的增加而增加（P〈0．05）。结论2型糖尿病患者合并甲状腺疾病患病率高,建议对女性2型糖尿病患者及男性患者中年龄超过60岁或病程大于10年者进行常规甲状腺功能检查。     

甲状腺过氧化酶抗体与非甲状腺相关性疾病

正临床上逐步发现,TPOAb阳性病人不仅伤害甲状腺,也常引起,或合并伤害其它组织器官疾病。1糖尿病大量研究表明,糖尿病的发生、发展有免疫因素的参与~([1])。这可能由于糖尿病与甲状腺疾病存在共同的发病机制,目前认为抗甲状腺过氧化物酶抗体(TPOAb)等抗体参与糖尿病的甲状腺功能障碍的发病过程~([2])。尤其是1型糖尿病与自体免疫性甲状腺疾病、与自其免疫性多发内分泌腺瘤综合征等自身免疫性内分泌疾病合并存在几率     

2型糖尿病合并甲状腺功能异常的诊治分析

目的探讨2型糖尿病合并甲状腺功能异常类型及治疗经验,提高临床诊治率。方法回顾性分析20例2型糖尿病合并甲状腺功能异常患者临床诊治资料,分析类型差异,经降糖治疗及甲状腺疾病对症处理后,观察患者血糖与甲状腺激素水平。结果本组2型糖尿病合并甲状腺功能亢进患者20.0%(4/20)明显低于甲状腺功能减退患者80.0%(16/20),两组疗效比较,差异有统计学意义(P<0.05)。经全面治疗后,全部患者甲状腺功能均恢复正常,无病死患者。结论 2型糖尿病合并甲状腺功能异常的临床表现易混淆,重视2型糖尿病患者存在甲状腺功能异常的筛查,是提高临床疗效的重要保证。     

230例住院2型糖尿病患者甲状腺功能分析

目的调查陕西凤翔地区住院2型糖尿病患者甲状腺疾病的患病情况。方法回顾性分析2013年4月—2015年3月在陕西省凤翔县医院内五科住院治疗的230例2型糖尿病患者的甲状腺功能。结果 230例2型糖尿病患者中甲状腺疾病的患病率为28.70%,其中甲亢2.17%,亚临床甲亢0.43%,甲减5.22%,亚临床甲减20.87%。145例检测甲状腺抗体的2型糖尿病患者中,甲状腺抗体(TPOAb或TgAb)阳性率为12.41%。女性2型糖尿病患者甲状腺疾病患病率、亚临床甲减患病率及甲状腺抗体阳性率明显高于男性(P0.05)。随着年龄增长,2型糖尿病患者中亚临床甲减患病率呈升高趋势(P0.05)。结论 2型糖尿病患者甲状腺疾病的患病率高,对于2型糖尿病患者积极检测甲状腺功能很有必要。     

2型糖尿病患者甲状腺功能异常的临床特征

目的总结2型糖尿病患者患病后甲状腺功能的变化特点。方法研究资料随机选自2014年1月—2017年7月入院治疗的2型糖尿病患者共262例,根据患者病例回顾性分析病情,探讨患者甲状腺功能的异常情况,总结疾病临床特点。结果在60例2型糖尿病合并甲状腺疾病患者中,女性患者41例(68.33%)亚临床甲减发病率最高为55.00%;且甲减组TG水平高于甲亢组(P0.05);甲亢组FPG与2 hPG水平明显高于甲减组(P0.05)。结论 2型糖尿病患者并发甲状腺异常疾病,且疾病种类复杂,因此在临床治疗中需定期对患者进行甲状腺功能相关指标的检查,达到更好治疗疾病的目的。     

1型糖尿病和自身免疫性甲状腺疾病的遗传易患性研究进展

1型糖尿病主要分为2型：IA型,与自身免疫相关;IB型,目前病因尚不清楚。本文将主要讨论IA型1型糖尿病。1型糖尿病是器官特异性自身免疫疾病,患者易合并其他自身免疫性疾病,其中最多见的是自身免疫性甲状腺疾病。     

老年2型糖尿病合并亚临床甲减患者sICAM-1与胰岛B细胞功能的相关性

<正>近年来,糖尿病与甲状腺疾病的关系受到国内外学者的广泛关注。2型糖尿病患者甲状腺功能异常的发生率高于普通人群,甲状腺功能异常以亚临床甲状腺功能减退症(亚临床甲减,SCH)为主。糖尿病合并SCH(DM+SCH)患者左心功能受损,心血管事件的风险增加,糖尿病视网膜病变增多,尿白蛋白升高[1-4]。目前研究显示SCH可能影响糖尿病患者的胰岛B细胞功能,本研究以老年2型糖尿病患者为研究对象,探讨SCH对胰岛功能的影响及其可能机制。     

马鞍山地区糖尿病患者合并甲状腺疾病的调查

调查2009年10月至2011年6月于十七冶医院就诊的423例糖尿病患者的甲状腺功能,其中299例患者作了甲状腺超声检查。结果 (1)糖尿病患者合并甲状腺疾病的患病率为43.27%,其中甲状腺功能减退者占26.36%(临床甲减8.55%,亚临床甲减18.11%),甲状腺功能亢进者16.91%(临床甲亢10.61%,亚临床甲亢6.30%),低T3综合征者6.11%。(2)糖尿病患者中甲状腺疾病患病率女性高于男性,差异有统计学意义(P<0.05)。结论糖尿病与甲状腺疾病均是常见的内分泌代谢性疾病,二者并存并非少见,有时症状叠加互相影响,甲状腺疾病可加速糖尿病的进程,促进某些慢性并发症的发生;对于糖尿病合并甲状腺疾病患者应两病兼治。     

几种生化指标在老年性糖尿病患者合并甲状腺功能减退中的临床意义

<正>甲状腺功能减退(甲减)是由于甲状腺激素合成及分泌减少或其生理效应不足所致机体代谢降低的一种疾病。2型糖尿病成年人多发,其主要病因为机体胰岛抵抗和/或胰岛素分泌不足引起。糖尿病合并甲状腺异常主要表现为甲状腺功能、甲状腺自身抗体及甲状腺形态异常,甲状腺功能异常主要表现为甲状腺功能减退。血清同型半胱氨酸是人体內含硫氨基酸的一个重要的中间代谢产物,可能是动脉粥样硬化等心脑血管疾病发生发展的一个独立危险因素,血清HCY     

糖尿病性心肌病的发病机制及治疗方法研究进展

心血管疾病是2型糖尿病的主要并发症,约占2型糖尿病患者死亡人数的2/3。血糖异常、血脂异常、胰岛素抵抗、慢性低度炎症、氧化应激、内皮功能障碍、血管钙化和高凝状态等多种病理生理过程可加快2型糖尿病患者糖尿病心脏病的进展。糖尿病性心肌病是糖尿病心脏病中较为常见的一种,可导致心功能异常并最终进展为心力衰竭、心律失常,甚至猝死。本文综述了糖尿病性心肌病的发病机制,以及当前及未来潜在的治疗方法。     

老年病与正常甲状腺病态综合征

正常甲状腺病态综合征是由于甲状腺以外的全身疾病、手术或禁食等引起甲状腺功能实验结果的异常.各年龄段均可发生,但以老年人及老年病最为常见.其中低T3综合征最常见.低T3综合征的发生机制包括机体“保护性”防御机制、硒缺乏、下丘脑-垂体-甲状腺轴异常、甲状腺激素结合球蛋白的改变等.各种老年病发生低T3综合征的风险均明显增加,如糖尿病、心力衰竭、慢性呼吸系统疾病及手术等.老年病伴低T3综合征者提示病情更重,因此正确判断甲状腺功能非常重要.低T3综合征是否需要治疗这一话题仍存在很大争议.     

Prevalence and progression of subclinical hypothyroidism in women with type 2 diabetes: the Fremantle Diabetes Study

OBJECTIVE: To assess the prevalence and progression of subclinical hypothyroidism in women with type 2 diabetes. DESIGN AND PATIENTS: Cross-sectional and longitudinal observational assessment of thyroid function in 420 adult females with type 2 diabetes randomly selected from participants in the community-based Fremantle Diabetes Study. Measurements Serum TSH, antibodies to thyroperoxidase (anti-TPO) and serum free T4 were measured at baseline and after 5 years. Baseline glycated haemoglobin (HbA(1c)), serum glucose, serum total and high density lipoprotein (HDL) cholesterol, serum triglycerides and antibodies to glutamic acid decarboxylase (anti-GAD) were also used in analyses. RESULTS: After exclusion of patients with known thyroid disease or taking amiodarone or lithium at baseline, the prevalence of subclinical hypothyroidism (a raised serum TSH and normal serum free T4) was 8.6%. Subclinical hypothyroidism was associated with anti-TPO status and age, but there were no independent associations with serum cholesterol, history of coronary heart disease, HbA(1c) or hypoglycaemic therapy. In the subgroup of patients restudied after 5 years, none of those who had subclinical hypothyroidism at baseline had overt hypothyroidism regardless of anti-TPO status. CONCLUSIONS: In women with type 2 diabetes without known thyroid disease, subclinical hypothyroidism is a common but incidental finding. The routine screening of thyroid function in type 2 diabetes is questionable.     

Diabetic ketoacidosis associated with recurrent pulmonary edema and rhabdomyolysis in a patient with Turner's syndrome

Turner's syndrome is a condition involving total or partial absence of one X chromosome and has been associated with a number of diseases including non insulin dependent diabetes mellitus, abnormalities of glucose metabolism and hypothreosis. There have been many case reports in which Turner's syndrome is associated with type 2 diabetes, but the association with type 1 diabetes and/or life threatening complications is very rare. We present an unusual case of a patient with Turner's syndrome who has type 1 diabetes and is complicated with ketoacidosis, severe acute and recurrent pulmonary edema and rhabdomyolysis.     

Coeliac disease in patients with type 1 diabetes mellitus and auto-immune thyroid disorders

The paper aims to review the prevalence and natural history of coeliac disease in patients with type 1A diabetes mellitus and autoimmune thyroid disorders. These diseases share a similar genetic background. In diabetic children and adults, the prevalence of (mostly asymptomatic) coeliac disease varies form 0.97 to 6.4%. Diabetes is usually diagnosed first. Screening in relatives may also be positive. Recurrent hypoglycaemia in diabetic subjects (indirectly) suggest the development of coeliac sprue. Thyroid disorders (thyroiditis and Graves' disease) are also usual in coeliac disease. A common etiopathogenic mechanism for the association CD/diabetes/thyroid disorders, with gluten as the driving antigen, was postulated. Thus, screening program for coeliac disease are recommended in individuals with type 1A diabetes and/or auto-immune thyroid conditions, as well as in their first-degree relatives.     

High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus

BACKGROUND: Thyroid autoantibodies (ThyAb) and subclinical hypothyroidism occur more frequently in pregnant women with insulin-dependent diabetes mellitus than in healthy pregnant women. Few studies have investigated the presence of ThyAb in women with gestational diabetes mellitus (GDM), and no significant association between diabetes in pregnancy and thyroid function has been reported. OBJECTIVE: To assess the thyroid biochemical profile and estimate the prevalence of ThyAb in a group of pregnant women at increased risk of GDM due to family and personal risk factors, and to investigate the relationship between a positive family history of diabetes or thyroid diseases and the eventual presence of ThyAb during pregnancy. METHODS: Oral glucose tolerance, serum ThyAb and thyroid function were evaluated in 181 pregnant women with increased risk for GDM (study group). Seventeen healthy pregnant women without risk factors for GDM and with a normal glucose tolerance were recruited as controls. RESULTS: The women who developed GDM showed a mean free thyroxine concentration significantly lower than that observed in the healthy pregnant women and in those with impaired gestational glucose tolerance and normal glucose tolerance. Twenty-nine of the 181 women in the study group (16%) were ThyAb positive. However, the risk of being ThyAb positive during pregnancy was three times greater in the women with positive family history of both diabetes mellitus and thyroid disease than in those with no family history of these conditions. CONCLUSIONS: This study showed that women with increased risk of GDM, mostly those with family history of diabetes mellitus and thyroid disease, also have an increased risk of being ThyAb positive during pregnancy. It also highlighted the importance of evaluating thyroid function in pregnant women with impaired glucose tolerance, in view of their increased risk of subclinical hypothyroidism.     

Genetic determinants of diabetes and atherosclerosis

Common risk factors for type 2 diabetes and cardiovascular disease are suspected because of the higher than expected prevalence of cardiovascular disease in individuals with newly diagnosed type 2 diabetes and in nondiabetic individuals with impaired glucose tolerance. Some of these risk factors may be genetic in origin. The risk of diabetes and cardiovascular disease may be linked through common pathways, including insulin resistance and/or inflammation. In this review, we describe the rationale for proposing these as common mechanisms affecting both diabetes and cardiovascular risk, and we then summarize the available evidence suggesting that common genes within these pathways have pleiotropic effects influencing susceptibility to both diseases.     

Sekundäre Diabetesformen

Other types of diabetes include diabetes forms which are induced by diseases of the pancreas or liver as well as drug-induced diabetes. In this context endocrine disorders as the cause of secondary diabetes are of special clinical interest: On the one hand a chronically insufficient metabolic control of diabetes can change endocrine parameters (e.g. thyroid hormone, growth hormone), while on the other hand acute imbalance of glucose control in diabetic patients could be induced by endocrine diseases. Hyperthyroidism in diabetics leads to increased insulin resistance and reduced insulin secretion, resulting in pronounced hyperglycemia. In contrast, hypothyroidism leads to increased insulin sensitivity and greater risk of hypoglycemia, especially in insulin-dependent diabetes. Pathologically increased growth hormone secretion and diseases of the adrenal gland may have pronounced effects on glucose metabolism. Given the known association between type 1 diabetes and other autoimmune endocrinopathies (polyglandular autoimmune syndrome, PAS), annual screening for these patients and their near relatives is recommended.     

嘉定区2型糖尿病并发高血压病治疗现状分析

目的:了解嘉定区社区内2型糖尿病并发高血压病患者治疗现况。方法:采用多阶段分层随机抽样方法在4个街镇随机抽取423例2型糖尿病并发高血压病患者,开展问卷调查、体格检查和实验室检查。结果:在413例资料完整的患者中,降压药规则服药率为90.8%,血压控制率为26.9%;单独使用一种降压药的患者278例,占74.1%。降糖药规则服药率为86.9%,血糖控制率为69.4%。高胆固醇血症、左心室肥厚和下肢外周动脉病是血压控制不良的危险因素,患糖尿病年限长、不规律服用降糖药、高三酰甘油血症和低密度脂蛋白过高是血糖控制不良的危险因素。结论:该地区2型糖尿病并发高血压病患者规范服药率达86.9%以上,血糖控制率为69.4%,而血压控制率仅达26.9%,与血糖和血压控制相关的独立可控因素是高脂血症和不规则服药。     

Genetic susceptibility and immunological synapse in type 1 diabetes and thyroid autoimmune disease.

Type 1 diabetes mellitus results from an immune mediated or idiopathic destruction of the pancreatic beta cells. Its aetiopathogenesis remains to be elucidated, despite great progress in the characterisation of beta-cell antigens, T-lymphocyte and antibody markers as well as whole genome screening. The incidence of type 1 diabetes is rising in most countries. Moreover, a considerable proportion of patients initially presenting with type 2 diabetes mellitus have an underlying type 1 diabetes with a latent course. A proportion of type 1 diabetes patients have concomittant thyroid autoimmune disease, either Hashimoto's thyroiditis or Graves' disease. Whereas Hashimoto's thyroiditis shares the same destructive immune process as type 1 diabetes, Graves' disease is unique in stimulating specifically the TSH-receptor through high-affinity immunoglobulins. However, both the thyroid autoimmune disorders and type 1 diabetes have susceptibility genes in common, implying shared pathways of immunopathogenesis. It has become clear that the genetic composition of a host at least partly determines the course of an immune response leading either to an organ-specific autoimmune disease or creating a state of balance where antibodies are hallmarks of (auto)immunity but normal function prevails. Genetic factors including MHC ( IDDM 1-genetic locus) and non-MHC genes (IDDM 2 - IDDM X) have been shown to determine susceptibility to autoimmunity in type 1 diabetes or lifelong tolerance. Currently the importance of the various diabetes associated genes is becoming clearer due to functional studies. Our review attempts to compile the relevant data that have accumulated in recent years and offers perspectives for prediction, prevention and possibly even therapy of immune-mediated endocrinopathies.