T2DM合并SCH患者血清hs-CRP、脂质水平及血管病变情况分析

Analysis of Serum hs-CRP,Lipid Levels and Vascular Lesions in T2DM Patients with Subclinical Hypothyroidism

目的观察2型糖尿病(T2DM)合并亚临床甲状腺功能减退(SCH)患者血清高敏C反应蛋白(hs-CRP)、脂质水平及血管病变情况。方法选择2012年3月至2014年9月河北工程大学附属医院收治的T2DM合并SCH者47例作为观察组,选取同期单纯T2DM患者55例作为对照组。两组患者均检测、计算体质指数(BMI)、促甲状腺素(TSH)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(Hb A_(1c))、hs-CRP、颈动脉内-中膜厚度(CIMT)、左心室射血分数(LVEF)、踝肱指数(ABI),并记录合并症的发生情况。结果观察组BMI、Hb A_(1c)、TG、LDL-C、TSH、hs-CRP、CIMT均高于对照组[(26.1±2.7)kg/m^2比(24.2±3.2)kg/m^2、(10.3±2.3)%比(9.3±1.2)%、(2.9±1.2)mmol/L比(2.1±0.3)mmol/L、(3.8±0.7)mmol/L比(3.2±0.7)mmol/L、(5.2±1.1)m U/L比(2.4±0.5)m U/L、(4.7±1.1)mg/L比(3.8±1.1)mg/L、(1.39±0.21)mm比(1.26±0.18)mm](均P<0.05);观察组游离三碘甲状腺原氨酸、游离甲状腺素、LVEF、ABI显著低于对照组[(3.8±0.9)pmol/L比(4.1±0.7)pmol/L、(13.1±2.7)pmol/L比(14.3±3.1)pmol/L、(56±7)%比(58±6)%、(0.87±0.24)比(1.21±0.17)](均P<0.05);观察组心血管疾病发生率均高于对照组[53.2%(25/47)比32.7%(20/55)](P<0.05)。结论 T2DM合并SCH患者血管病变发生率增加,脂代谢水平异常、炎症反应参与血管病变的形成;此类患者应注意hs-CRP水平变化。

Objective To investigate the influence of subclinical hypothyroidism（SCH）on serum high sensitivity C-reactive protein（hs-CRP）,lipid levels and diabetic vascular complications in patients with type 2 diabetes mellitus（T2DM）.Methods Patients with T2DM admitted in Affiliated Hospital of Hebei University of Engineering from Mar.2012 to Sep.2014 were included in the study.47 cases with T2DM and SCH were included as an observation group;55 cases with simple T2DM were included as a control group.The Levels of body mass index（BMI）,thyroid-stimulating hormone（TSH）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,high density lipoprotein cholesterol（HDL-C）,glycosylated hemoglobin（Hb A_（1c））,hs-CRP,carotid intima-media thickness（CIMT）,ankle brachial index（ABI）,LVEF were measured.The incidence of complications was detected and analyzed.Results The levels of BMI,Hb A_（1c）,TG,LDL-C,TSH,hs-CRP,CIMT in the observation group were higher than those in the control group[（26.1±2.7）kg/m^2vs（24.2±3.2）kg/m^2,（10.3±2.3）%vs（9.3±1.2）%,（2.9±1.2）mmol/L vs（2.1±0.3）mmol/L,（3.8±0.7）mmol/L vs（3.2±0.7）mmol/L,（5.2±1.1）m U/L vs（2.4±0.5）m U/L,（4.7±1.1）mg/L vs（3.8±1.1）mg/L,（1.39±0.21）mm vs（1.26±0.18）mm]（all P〈0.05）.The levels of free triiodothyronine,free thyroid hormones,LVEF,ABI in the observation group were lower than those in the control group[（3.8±0.9）pmol/L vs（4.1±0.7）pmol/L,（13.1±2.7）pmol/L vs（14.3±3.1）pmol/L,（56±7）%vs（58±6）%,（0.87±0.24）vs（1.21±0.17）]（all P〈0.05）.The incidence of cardiovascular disease in the observation group was higher than that in the control group[53.2%（25/47）vs 32.7%（20/55）]（P〈0.05）.Conclusion The incidence of vascular complications is increased in patients with T2DM combined with SCH.Abnormal lipid metabolism and inflammatory reaction are involved in the formation of vascular diseases.Patients with SCH and T2DM should pay attention to the change of hs-CRP.