The Relationship Between Diabetic Retinopathy And Subclinical Hypothyroidism

Background and objectiveDiabetic Retinopathy(DR)as one of the most common diabetic microangiopathy,is the leading cause of visual impairment and blindness in working-aged people.At present,Guidelines for the prevention and control of type 2 diabetes in China(2017Edition)and Expert consensus on the prevention and treatment of diabetic retinopathy have listed subclinical hypothyroidism(SCH)as a risk factor for DR,which has gradually been valued by clinician.However,there is still controversy about the correlation between SCH and DR.Our study retrospectively analyzed the clinical data of 687 patients with type 2 diabetes,aiming to examine whether SCH is associated with DR.MethodsFrom September 2017 to June 2018,we collected 687 patients data with type 2diabetes mellitus in the Metabolic Disease Hospital of Tianjin Medical University.The following information was obtained from the medical records:demographical characteristics,previous history,duration of diabetes,blood pressure,laboratory-related examinations,and fundus photography.According to thyroid function,the participants were divided into the SCH group and EUT group.According to the 2012 Kidney Disease:Improving Global Outcomes of chronic kidney disease evaluation and management of clinical practice guidelines presented in the cause-GFR-albuminuria stage,risk of kidney disease was graded in the subjects:G1A1 G2A1 period for low-risk group,G1A2 G2A2 G3aA1 period for moderate groups,G1A3 G2A3 G3aA2 period for high-risk groups,G3aA3 period for very high-risk group.According to the fundus photography,the subjects were divided into the DR group and the NDR group.The guidelines from the National Academy of Clinical Biochemistry state that more than 95%of healthy individuals have a serum TSH concentration lower than 2.5 mU/L.The participants were divided into T1 group and T2 group.Then analyze the relationship between DR and SCH..Result1.A total of 687 patients with type 2 diabetes were enrolled in this study,with the mean age of 56.32±11.61 years,the average duration of diabetes of 10.70±7.52years,and the average BMI of 26.79±4.01(kg/m~2).There were 255 female patients and 432 male patients,76 patients in the SCH group,611 patients in the EUT group.There were 213 patients in the DR group,474 patients in the NDR group.2.With SCH as the independent variable and DR as the dependent variable,multivariate logistics regression analysis showed that the OR value after adjusting different influencing factors(95%CI),P value were(OR=1.505,95%CI:0.891-2.543,P=0.126)(MODEL1),(OR=1.543,95%CI:0.884-2.695,P=0.127)(MODEL2),(OR=1.423,95%CI:0.802-2.525,P=0.227)(MODEL3).There was no correlation between these two diseases.But women,age,TPO-Ab,and a high-risk group of kidney disease risk grade were independent risk factors for SCH.3.Using TSH as an independent variable and DR as a dependent variable for regression analysis,the OR value after adjusting confounding factors(95%CI),P value were(OR=1.141,95%CI:1.040-1.253,P=0.005)(MODEL1),(OR=1.154,95%CI:1.044-1.275 P=0.005)(MODEL2),(OR=1.143,95%CI:1.032-1.265,P=0.010)(MODEL3).There was a significant correlation between DR and TSH.At the same time,age,female,diabetes duration,hypertension,HbA1c and high-risk renal disease classification were independent risk factors for DR.4.Using T2 as independent variables and DR as dependent variable for multivariate logistic regression analysis,the OR values after adjusting different influencing factors,(95%CI),P values were(OR=1.415,95%CI:1.002-2.000,P=0.049)(MODEL1),(OR=1.483,95%CI:1.03-2.136,P=0.034)(MODEL2),(OR=1.499,95%CI:1.035-2.173,P=0.034(MODEL3).The prevalence of DR in patients with TSH<2.50mIU/L is lower.Conclusion1.In T2DM patients,DR is positively correlated with TSH.TSH may be a risk factor for DR.2.In T2DM patients,with TSH>4.2mIU/L to define the SCH,failed to confirm correlation between SCH and DR,but we found kidney disease classification was significantly related with SCH and DR.Therefore,more attention should be paid to the renal and fundus conditions of patients with T2DM complicated with SCH in clinical work.3.In patients with T2DM,the prevalence of DR in patients with TSH≥2.50mIU/L is significantly higher than that in patients with TSH<2.50mIU/L,It suggests that T2DM patients with TSH≥2.50mIU/L should pay close attention to fundus lesions and be alert to the occurrence and development of DR in clinical work.