老年2型糖尿病患者合并亚临床甲状腺功能减退症对心脏及大血管功能的影响

Effect of subclinical hypothyroidism on cardiac and macrovascular diseases in elderly patients with type 2 diabetes

目的探讨亚临床甲状腺功能减退（甲减）症对老年2型糖尿病患者大血管并发症的影响。方法从2013年6月至2015年6月在黑龙江省医院南岗院区内分泌科就诊的368例老年2型糖尿病患者中≥60岁的老年2型糖尿病合并亚临床甲减患者35例作为观察组；按照配对原则选择同期甲状腺功能正常的糖尿病患者35例为对照组。比较两组患者空腹血糖（FPG）、总胆固醇（TC）、甘油三酯（TG）、左心室舒张功能（E／A）、左心室射血分数（LVEF）、踝肱指数（ABI）差异，初步探讨亚临床甲减对糖尿病大血管并发症的影响。结果两组比较，血清促甲状腺激素（TSH）水平偏高（P〈0．001），总胆固醇（TC）水平亦偏高（P=0．002），而左心室射血分数（LVEF）偏低（P=0．043）。两组间E／A、ABI比较，差异均无统计学意义（P〉0．05）。结论亚临床甲减可能引起老年左心室收缩功能减退，对大血管并发症的其他影响需进行深入研究。

Objective To determine the effect of subclinical hypothyroidism （SHT） on diabetic macrovascular diseases in the elderly with type 2 diabetes mellitus. Methods Among the 368 type 2 diabetic subjects who admitted in our department from June 2013 to June 2015, 35 subjects complicated with SHT （aged over 60 years） and 35 matched subjects without SHT were selected and enrolled in this study. Fasting plasma glucose （FPG）, total cholesterol （TC）, triglycerides （TG）, left ventricular ejection fraction （LVEF）, and E/A ratio [left ventricular early diastolic mitral flow velocity （E） to left ventricular end diastolic mitral flow velocity （A）] and ankle-braehial index （ABI） were compared between the 2 groups in order to determine the effect of SHT on diabetic macrovascular diseases. Results The serum levels of thyroid stimulating hormone （TSH, P〈 0.001） and TC （P= 0.002） were significantly higher, while LVEF was obviously lower （P =0.043） in the SHT group than in the euthyroid group. But there were no remarkable differences in the the E/A ratio and ABI between the 2 groups （P 〉 0.05）. Conclusion Subclinical hypothyroidism may cause left ventrieular systolic dysfunction in the elderly with type 2 diabetes mellitus, but its effect on diabetic maerovascular diseases needs further investigation.