甲状腺功能正常的2型糖尿病患者血清甲状腺激素水平与糖尿病周围神经病变的相关性研究

Association between serum thyroid hormone levels and diabetic peripheral neuropathy in euthyroid patients with type 2 diabetes mellitus

目的探讨甲状腺功能正常的T2DM患者血清甲状腺激素(TH)水平与糖尿病周围神经病变(DPN)的相关性。方法选取2018年6月至2019年12月于南昌大学第三附属医院内分泌科住院治疗的T2DM患者1114例,分为合并DPN组(DPN,n=415)和单纯T2DM组(T2DM,n=699),比较两组各项指标,Logistic回归分析DPN的影响因素,分析不同血清游离三碘甲状腺原氨酸(FT_(3))水平与DPN风险的相关性。受试者工作特征曲线(ROC)分析FT_(3)对DPN的诊断价值。结果DPN组男性比例、DM病程、吸烟史、WHR、FPG、2 h PG、Hb A1c、血肌酐(Scr)均高于T2DM组(P<0.05),FC-P、2 h C-P、谷丙转氨酶、谷草转氨酶、FT_(3)、FT_(3)/血清游离甲状腺素比值低于T2DM组(P<0.05)。Logistic回归分析显示,校正性别、DM病程、Hb A1c、2 h C-P后,FT_(3)是T2DM患者DPN的影响因素(P<0.01)。根据FT_(3)水平将患者进行四分位分组(Q1、Q2、Q3、Q4),Q2、Q3、Q4组DPN患病率低于Q1组(P<0.05或P<0.01)。ROC曲线下面积为0.568。结论FT_(3)是T2DM患者DPN的影响因素,但不能作为预测DPN患病风险的因素。

Objective To explore the association between thyroid hormone(TH)level and diabetic peripheral neuropathy(DPN)in euthyroid patients with type 2 diabetes mellitus(T2DM).Methods A total of 1114 patients with T2DM were enrolled and divided into DPN group(n=415)and non-DPN(T2DM)group(n=699).The indicators of the two groups were compared.Logistic regression was used to analyze the risk factors for DPN.The correlation between different FT_(3)levels and DPN risk was analyzed.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic value of FT_(3)for DPN.Results Proportion of men,duration of diabetes,smoking rate,WHR,FPG,2 h PG,Hb A1c and Scr were higher,while FC-P,2 h C-P,ALT,AST,FT_(3)and FT_(3)/FT4were lower in DPN group than in T2DM group(P<0.05).Logistic regression analysis showed that FT_(3)was an independent influencing factor for T2DM after adjusting for gender,DM duration,Hb A1c,and 2 h C-P(P<0.01).According to the serum FT_(3)level,patients were quartile grouped(Q1,Q2,Q3,Q4).The prevalence of DPN was lower in Q2,Q3 and Q4 group than in Q1 group(P<0.05 or P<0.01).AUC was 0.568.Conclusion FT_(3)was an influencing factor for T2DM.However,it was not sufficient in DPN prediction.