Subclinical Hypothyroidism and Type 2 Diabetes: A Systematic Review and Meta-Analysis.
Subclinical Hypothyroidism and Type 2 Diabetes: A Systematic Review and Meta-Analysis.
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亚临床甲状腺功能减退症和 2 型糖尿病：系统回顾和荟萃分析
DOI：
10.1371/journal.pone.0135233
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Teng W
中科院分区：
文献类型：
--
作者：
Han C;He X;Xia X;Li Y;Shi X;Shan Z;Teng W
背景大量证据表明亚临床甲状腺功能减退症（SCH）与2型糖尿病（T2DM）之间存在关联，但文献中的小样本量和不确定性数据使这一论断复杂化。目的了解2型糖尿病（T2DM）人群中SCH的患病率，探讨T2DM是否增加SCH的风险，以及SCH是否与糖尿病并发症有关。方法采用Meta分析方法，检索PubMed、EMBASE、Web of Science、万方、CNKI和维普数据库。我们获得了1980年1月1日至2014年12月1日期间发表的研究。选择这些研究以评价T2DM受试者中SCH的患病率，比较T2DM受试者与非糖尿病受试者中SCH的患病率，并研究SCH中糖尿病并发症是否比甲状腺功能正常的受试者更常见。采用固定和随机效应荟萃分析模型，结果以合并患病率和95%置信区间（95% CI）或汇总比值比（OR）和95% CI表示。结果经文献检索，符合纳入标准的文献36篇，共61篇。漏斗图和Egger检验显示，除了T2DM中SCH的合并患病率（P = 0.08）和T2DM中SCH的OR（P = 0.04）外，我们的研究中没有发表偏倚。采用Trim and fill方法对结果进行修正，并分别替换了5个可能缺失的数据。T2DM患者中SCH的校正汇总患病率为10.2%，同时，T2DM与SCH风险增加1.93倍相关（95% CI：1.66，2.24）。此外，SCH可能影响糖尿病并发症的发生，总OR为1.74（95% CI：1.34，2.28）糖尿病肾病，1.42（95% CI：1.21，1.67），外周动脉疾病1.85（95% CI：1.35，2.54），糖尿病周围神经病变1.87（95% CI：1.06，3.28）。结论T2DM患者发生SCH的可能性高于健康人群，SCH可能与糖尿病并发症增加有关。对T2DM患者进行甲状腺功能筛查是必要的，对合并SCH的T2DM患者除进行甲状腺功能检查外，还应给予适当的个体化治疗。
Background Abundant evidence suggests an association between subclinical hypothyroidism (SCH) and type 2 diabetes mellitus (T2DM), but small sample sizes and inconclusive data in the literature complicate this assertion. Objective We measured the prevalence of SCH in T2DM population, and investigated whether T2DM increase the risk of SCH and whether SCH was associated with diabetic complications. METHODS We conducted a meta-analysis using PubMed, EMBASE, Web of Science, Wan Fang, CNKI and VIP databases for literature search. We obtained studies published between January 1, 1980 to December 1, 2014. The studies were selected to evaluate the prevalence of SCH in T2DM subjects, compare the prevalence of SCH in T2DM subjects with those non-diabetics, and investigate whether diabetic complications were more prevalent in SCH than those who were euthyroid. Fixed and random effects meta-analysis models were used, and the outcome was presented as a pooled prevalence with 95% confidence interval (95% CI) or a summary odds ratio (OR) with 95% CI. RESULTS Through literature search, 36 articles met the inclusion criteria and these articles contained a total of 61 studies. Funnel plots and Egger’s tests showed no publication bias in our studies, except for the pooled prevalence of SCH in T2DM (P = 0.08) and OR for SCH in T2DM (P = 0.04). Trim and fill method was used to correct the results and five potential missing data were replaced respectively. The adjusted pooled prevalence of SCH in T2DM patients was 10.2%, meanwhile, T2DM was associated with a 1.93-fold increase in risk of SCH (95% CI: 1.66, 2.24). Furthermore, SCH might affect the development of diabetic complications with an overall OR of 1.74 (95% CI: 1.34, 2.28) for diabetic nephropathy, 1.42 (95% CI: 1.21, 1.67) for diabetic retinopathy, 1.85 (95% CI: 1.35, 2.54) for peripheral arterial disease, and 1.87 (95% CI: 1.06, 3.28) for diabetic peripheral neuropathy. Conclusions T2DM patients are more likely to have SCH when compared with healthy population and SCH may be associated with increased diabetic complications. It is necessary to screen thyroid function in patients with T2DM, and appropriate individualized treatments in addition to thyroid function test should be given to T2DM patients with SCH as well.