2型糖尿病合并冠心病与亚临床甲状腺功能减退症的关系

Relationship between coronary heart disease and subclinical hypothy-roidism in patients with type 2 diabetes mellitus

目的研究2型糖尿病（T2DM）合并冠心病（CHD）与亚临床甲状腺功能减退症（亚甲减）的关系。方法选择2013年1~6月于首都医科大学附属北京朝阳医院住院的T2DM患者350例,根据是否合并CHD分为CHD组和无CHD组,根据促甲状腺激素（TSH）水平分为甲状腺功能（甲功）正常组和亚甲减组,对CHD组和无CHD组相关指标进行比较并分析T2DM合并CHD的危险因素。结果 CHD组的年龄、病程、低密度脂蛋白胆固醇、糖化血红蛋白和TSH均明显高于无CHD组（P〈0.01或P〈0.05）。亚甲减组CHD的患病率[53.6%（15/28）]明显高于甲功正常组[28.6%（92/322）]（P=0.009）。Logistic回归分析提示糖化血红蛋白、低密度脂蛋白胆固醇和TSH均是T2DM合并CHD的危险因素（OR=1.148,P=0.031;OR=1.592,P=0.003;OR=1.494,P〈0.01）。结论T2DM合并CHD患者的TSH明显高于无CHD的T2DM患者。T2DM合并亚甲减患者的CHD患病率明显高于甲功正常患者,TSH升高是T2DM合并CHD的危险因素。

Objective To profile the relationship between coronary heart disease（CHD） and subclinical hypothyroidism（SCH） in patients with type 2 diabetes mellitus（T2DM）. Methods From January to June 2013, 350 patients with T2 DM admitted to Beijing Chaoyang Hospital, Capital Medical University were enrolled. All patients were divided into CHD group and non-CHD group. Also, according to the level of thyroid stimulating hormone（TSH）, patients were divided into euthyroid（ET） group and subclinical hypothyroidism（SCH） group. The general information and clinical characteristics in CHD group and non-CHD group were compared, and the risk factors in T2 DM patients with CHD were analyzed. Results The age, course of diease, low density lipoprotein cholesterol, glycosylated hemoglobin A1 cand TSH in CHD group were significantly higher than non-CHD group（P〈0.01 or P〈0.05）. Incidence of CHD in SCH group[53.6%（15/28）] showed significantly higher than ET group [28.6%（92/322）]（P = 0.009）. Logistic regression showed that glycosylated hemoglobin A1 c, low density lipoprotein cholesterin and TSH were risk factors in T2 DM patients with CHD（OR = 1.148, P = 0.031; OR = 1.592, P = 0.003; OR = 1.494, P〈0.01）. Conclusion TSH is higher in CHD group than non-CHD group in T2 DM patients. Higher incidence of CHD is found in T2 DM patients with SCH, and increased TSH is independent risk factor in T2 DM patients with CHD.