老年2型糖尿病合并亚临床甲状腺功能减退对颈动脉粥样硬化的影响

Effects of Subclinical Hypothyroidism on Carotid Artery in Elderly Patients with Type 2 Diabetes Mellitu

目的探讨老年2型糖尿病合并亚临床甲状腺功能减退(SCH)的患者与颈动脉病变的关系方法选取2017年6月-2018年12月住院的60岁以上资料完整的老年2型糖尿病患者120例作为研究对象,检测糖化血红蛋白、空腹血糖、餐后血糖、空腹C肽、餐后2hC肽、三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白及游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)等,同时采用高分辨彩色多谱勒超声测定颈动脉内膜厚度(IMT)及有无斑块形成。选择FT3、FT4正常,但TSH>4.2 IU/mL为亚临床甲状腺功能减退症(SCH)的诊断切点,将患者分为2型糖尿病组(n=95)和2型糖尿病合并SCH组(n=25)。以是否存在颈动脉粥样硬化作为因变量,其他各项生化指标作为自变量,用Logistic回归分析,进行相关性分析。结果(1)2组患者在性别、年龄、CRP、谷丙转氨酶、血肌酐、餐后2 h血糖、糖化血红蛋白、空腹C肽差异均无统计学意义(P>0.05),而2组之间的总胆固醇、低密度脂蛋白(mmol/L)、三酰甘油(mmol/L)、空腹血糖、餐后2 h胰岛功能差异有统计学意义(P<0.05)。(2)2型糖尿病组的平均CIMT为0.70(0.24,1.54),而2型糖尿病合并SCH组的平均CIMT为1.00(0.60,8.50)mm,2组间差异具有统计学意义(P=0.000)。将IMT≥1.0 mm或合并有明显斑块的受检对象诊断为颈动脉粥样硬化,2型糖尿病组有59例(67.0%)而2型糖尿病合并SCH组有23例(92.0%),差异有统计学意义(P=0.014)。回归分析显示CIMT分别与LDLC(r=-0.267,P=0.035)呈负相关。(3)以颈动脉粥样硬化病变数为因变量,以性别、年龄、空腹C肽、2 h C肽、糖化血红蛋白、低密度脂蛋白等为自变量,行Logistic回归分析,结果提示年龄及TSH为颈动脉粥样硬化的独立危险因素。结论老年2型糖尿病患者合并亚临床甲状腺功能减退患者颈动脉粥样硬化的发生随着年龄和TSH的增高而增高。

Objective To investigate the effects of subclinical hypothyroidism on carotid artery in elderly patients with type 2 diabetes mellitu.Methods 120 elderly patients with type 2 diabetes over 60 years of age with complete clinical data were selected as the research subjects.Their glycated hemoglobin,fasting blood glucose,postprandial blood glucose,fasting C peptide,postprandial 2 h C peptide,triacylglycerol,total cholesterol,high-density lipoprotein,low-density lipoprotein,and free triiodothyronine(FT3),free thyroxine(FT4),and thyroid stimulating hormone(TSH)were measured;the carotid intima thickness(IMT)and presence or absence of plaque formation were determined by high-resolution color Doppler ultrasound.Taking FT3 and FT4 as normal,but TSH>4.2 IU/m L as the diagnosis point of subclinical hypothyroidism(SCH),the patients were divided into type 2 diabetes group(n=95)and type 2 diabetes combined with SCH group(n=25).The presence or absence of carotid atherosclerosis was used as the dependent variable,and other biochemical indicators were used as the independent variables.Logistic regression was used for correlation analysis.Results(1)There were no significant differences in sex,age,CRP,GPT,serum creatinine,blood glucose,Hb A1 c and fasting C-peptide between the two groups(P>0.05).The total cholesterol,low-density lipoprotein,triglyceride,fasting blood glucose and 2 h postprandial islet function were significant different between the two groups(P<0.05).(2)The CIMT of type 2 diabetes group was significantly lower than that of type 2 diabetes combined with SCH group(P=0.000).IMT≥1.0 mm or combined with obvious plaque was used as the diagnostic criteria for carotid atherosclerosis.There were 59 cases(67.0%)in type 2 diabetes group and 23 cases(92.0%)in type 2 diabetes combined with SCH group(P=0.014).Regression analysis showed that CIMT was negatively correlated with LDL-C(r=-0.267,P=0.035).(3)The number of carotid atherosclerotic lesions was used as the dependent variable,and sex,age,fasting C-peptide,2 h C-peptide,glycosylated hemoglobin,low-density lipoprotein were used as the independent variables.The results of logistic regression analysis showed that age and TSH were the independent risk factors of carotid atherosclerosis.Conclusion The occurrence of carotid atherosclerosis in elderly patients with type 2 diabetes mellitus and subclinical hypothyroidism increased with the increase of age and TSH.