促甲状腺激素水平与2型糖尿病患者周围神经病变的相关性

Correlation between thyroid stimulating hormone and peripheral neuropathy in patients with type 2 diabetes mellitus

目的探讨促甲状腺激素(TSH)水平与2型糖尿病患者周围神经病变的相关性。方法选取2014年12月至2016年4月于火箭军总医院内分泌科住院的97例2型糖尿病患者作为研究对象。根据是否合并糖尿病周围神经病变(DPN)分为DPN组(50例)和非DPN组(47例),比较2组临床特征。检测血清TSH水平及相关临床指标,分析TSH与其他临床特征的相互关系,分析DPN的风险因素,分析不同TSH水平与DPN风险的相关性。结果 DPN组年龄大于、糖尿病病程长于、高血压家族史比例大于、TSH水平低于非DPN组,差异均有统计学意义(均P<0. 05)。Spearman相关分析结果显示糖尿病病程与年龄、DPN呈正相关(P <0. 01),TSH与DPN呈负相关(P <0. 05)。多元Logistic回归分析结果显示糖尿病病程是DPN的独立危险因素(比值比=1.157,95%置信区间:1.054～1.269,P=0.002)。当TSH>3.225 mIU/L时有高的DPN风险(比值比=0.30,95%置信区间:0.09～0.98,P=0.046)。按性别分析,当TSH>3. 225 mIU/L时,男性存在高的DPN风险(比值比=0.12,95%置信区间:0. 02～0. 89,P=0.038),女性不存在高的DPN风险(P>0.05)。结论在2型糖尿病男性患者中TSH水平接近正常值上限时DPN的风险上升。

Objective To analyze the correlation between thyroid stimulating hormone（TSH） and peripheral neuropathy in patients with type 2 diabetes mellitus. Methods From December 2014 to April 2016, 97 patients with type 2 diabetes admitted in Rocket Force General Hospital of the Chinese People′s Liberation Army were divided into diabetic peripheral neuropathy（DPN） group（n=50） and non-DPN group（n=47）. TSH level and related clinical indicators were analyzed. Results In the DPN group, age, duration of diabetes and family history of hypertension ratio were higher and TSH level was lower than those in the non-DPN group（P〈0.05）. Spearman correlation analysis showed that duration of diabetes was positively correlated with age and DPN（P〈0.01）; TSH level was negatively correlated with DPN（P〈0.05）. Multivariate Logistic regression analysis showed that long duration of diabetes（odds ratio=1.157, 95% confidence interval： 1.054-1.269, P=0.002） and TSH〉3.225 mIU/L（odds ratio=0.300, 95% confidence interval： 0.092-0.981, P=0.046） were independent risk factors of DPN. In different sex groups, TSH〉3.225 mIU/L indicated a high risk of DPN in men（odds ratio=0.125, 95% confidence interval： 0.018-0.887, P=0.038） but not in women（P〉0.05）. Conclusion The risk of DPN increases in men with type 2 diabetes when TSH level approaching the upper normal limit.