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桥本氏病与1型糖尿病并存是否会影响糖尿病的控制及其并发症的发展?

Does concomitance of Hashimoto's disease and type 1 diabetes affect diabetes control and development of its complications?

作者信息

Szcześniak Grzegorz, Kozak-Nurczyk Patrycja, Dziemidok Piotr

机构信息

Department of Diabetology, Institute of Rural Health, Lublin, Poland.

出版信息

Arch Med Sci. 2019 Nov 16;17(4):900-904. doi: 10.5114/aoms.2019.89780. eCollection 2021.

Abstract

INTRODUCTION

Autoimmune diseases concomitant with diabetes may complicate the treatment and adversely affect the prognosis. The most common is Hashimoto's disease (HD). We compared diabetes control and prevalence of chronic complications in type 1 diabetes patients differing in the coexistence of HD.

MATERIAL AND METHODS

Medical records of 188 type 1 diabetics were analysed. Hashimoto's disease was diagnosed based on medical history, as well as determination of the levels of thyroid peroxidase antibodies, hormones and ultrasound examination. Statistical analysis was performed using Statistica 10PL.

RESULTS

HD was diagnosed in 43 (23%) patients. The mean HbA was 8.8 ±1.5% in the group with HD, and 9 ±1.6% in the group without HD (ns). The prevalence of diabetes complications was similar in both groups: ischaemic heart disease was diagnosed in 19% of patients with HD and 19% without HD, cerebral vascular insufficiency - 8% and 7%, peripheral neuropathy - 14% and 12%, sensory polyneuropathy - 47% and 46%, diabetic foot - 7% and 8%, Charcot osteoarthropathy - 7% and 2%, cardiovascular neuropathy - 21% and 28%, neuropathy of the gastrointestinal tract - 5% and 6%, nephropathy - 12% and 19%, retinopathy - 42% and 43%, and cataract in 28% and 19%, respectively. Impaired hypoglycaemia perception was rarer in the group with HD: 9% vs. 25% ( ≈ 0.04).

CONCLUSIONS

Hashimoto's disease does not significantly affect the level of type 1 diabetes control or the development of its complications. Only autonomic neuropathy in the form of impaired awareness of hypoglycaemia is rarer in patients with that thyroiditis.

摘要

引言

与糖尿病并发的自身免疫性疾病可能使治疗复杂化并对预后产生不利影响。最常见的是桥本氏病(HD)。我们比较了存在HD与否的1型糖尿病患者的血糖控制情况和慢性并发症的患病率。

材料与方法

分析了188例1型糖尿病患者的病历。根据病史、甲状腺过氧化物酶抗体水平测定、激素检测及超声检查诊断桥本氏病。使用Statistica 10PL进行统计分析。

结果

43例(23%)患者被诊断为HD。HD组的平均糖化血红蛋白(HbA)为8.8±1.5%,无HD组为9±1.6%(无显著差异)。两组糖尿病并发症的患病率相似:HD组和无HD组缺血性心脏病的诊断率均为19%,脑血管供血不足分别为8%和7%,周围神经病变分别为14%和12%,感觉性多发性神经病变分别为47%和46%,糖尿病足分别为7%和8%,夏科氏关节病分别为7%和2%,心血管神经病变分别为21%和28%,胃肠道神经病变分别为5%和6%,肾病分别为12%和19%,视网膜病变分别为42%和43%,白内障分别为28%和19%。HD组低血糖感知受损的情况较少见:9% 对25%(P≈0.04)。

结论

桥本氏病对1型糖尿病的控制水平或其并发症的发生无显著影响。只有以低血糖意识受损形式存在的自主神经病变在患有该甲状腺炎的患者中较为少见。

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