甲状腺功能在T2DM 10a心血管病风险评估中的应用

Application of Thyroid Function in 10-year Cardiovascular Disease Risk Assessment of T2DM

目的检测并分析甲状腺功能与心血管病相关指标的关系,探讨T2DM患者未来10 a心血管病发生及死亡风险的评估中是否需考虑纳入甲状腺功能。方法回顾昆明医科大学第二附属医院内分泌科2018年1月至2020年12月符合2型糖尿病诊断标准住院患者527例,从中收集有2型糖尿病合并亚临床甲状腺功能减退症者100例,既往无心脏瓣膜病或心肌病史,作为病例组(DM+SCH组);从527例2型糖尿病患者中分层随机选取既往无心脏瓣膜病或心肌病史的甲功正常者100例作为对照组(DM组),收集所有患者的基础资料及生化、影像学检查结果,并进行组间比较,应用Pearson相关分析促甲状腺激素分别与血脂如总胆固醇(total cholesterol,TC)、甘油三酯(triacyl glycerol,TG),心功能指标如左室射血分数(left ventricular ejection fraction,LVEF)、心输出量(cardiac output,CO)、心脏指数(cardiac index,CI)及二尖瓣口舒张早期和晚期充盈速度的比值(E/A比值)等的相关性,评估甲状腺功能与心血管病相关指标的相关性。结果研究对象中合并亚临床甲状腺功能减退症者共100例,患病率为18.98%。DM+SCH组女性病例数高于DM组,差异有统计学意义(P<0.05)。DM+SCH组较DM组TSH水平明显升高,TT3、FT3、TT4、FT4、RT3水平均降低,TG-Ab水平明显升高,差异有统计学意义(P<0.05,P<0.01)。DM+SCH组血清中TC、LDL-C水平及LDL-C/HDL-C较DM组升高,差异有统计学意义(P<0.01)。DM+SCH组CO、LVEF、E峰、E/A比值降低,血管阻力增高,差异有统计学意义(P<0.05,P<0.01)。Pearson相关分析TC、LDL-C水平与TSH水平呈正相关(P<0.05、P<0.01);CO、LVEF、E峰、E/A值与TSH水平呈负相关(P<0.05、P<0.01),血管阻力与TSH水平呈正相关(P<0.05)。结论(1)2型糖尿病合并亚临床甲状腺功能减退症者血脂及部分心功能与TSH相关;(2)2型糖尿病患者未来10 a心血管疾病发生风险及心血管相关死亡风险的评估中应纳入甲状腺功能。

Objective To investigate the relationship between thyroid function and cardiovascular diseaserelated indicators,and explore feasibility of thyroid function in the risk assessment of cardiovascular disease and death in T2DM patients in the next 10 years.Methods A retrospective study was performed on 527 inpatients who met the diagnostic criteria for type 2 diabetes in the Department of Endocrinology,The Second Affiliated Hospital of Kunming Medical University from January 2018 to December 2020.Among them,100 patients with type 2 diabetes complicated with subclinical hypothyroidism without previous history of valvular heart disease or myocardial infarction were enrolled as case group(DM+SCH group);100 patients with normal thyroid function without previous history of valvular heart disease or myocardial infarction were stratified and randomly selected from the 527 patients with type 2 diabetes as control group(DM group).Data of basic characteristics,blood chemistry and imaging of all patients were collected,and comparison between groups was conducted.Pearson correlation analysis was used to analyze the levels of thyroid stimulating hormone and blood lipids such as total cholesterol(TC)and Triacyl triglycerol(TG),respectively.Cardiac function indicators include left ventricular ejection fraction(LVEF),cardiac output(CO),cardiac index(Cardiac index).CI)and ratio of early and late mitral valve diastolic filling speed(E/A ratio)were collected to evaluate the correlation between thyroid function and cardiovascular disease related indicators.Results There were 100 patients with subclinical hypothyroidism among all the patients in this study,the prevalence rate is 18.98%.The female cases in DM+SCH group were significantly higher than DM group,the difference was statistically significant(P<0.05).Compared with DM group,TSH level in DM+SCH group was significantly higher,TT3,FT3,TT4,FT4 and RT3 levels were decreased,and TG-AB level was significantly higher,with statistical significance(P<0.05,P<0.01).The serum levels of TC,LDL-C and LDL-C/HDL-C in DM+SCH group were higher than those in DM group,and the differences were statistically significant(P<0.01).In DM+SCH group,CO,LVEF,E peak,E/A ratio decreased,and vascular resistance increased,with statistically significant difference(P<0.05,P<0.01).Pearson correlation analysis showed that TC and LDL-C levels were positively correlated with TSH levels(P<0.05,P<0.01).CO,LVEF,E peak and E/A were negatively correlated with TSH level(P<0.05,P<0.01),while vascular resistance was positively correlated with TSH level(P<0.05).Conclusions 1.TSH is associated with lipid profile and partial cardiac function in type 2 diabetes mellitus with subclinical hypothyroidism.2.Thyroid function should be included in the assessment of the occurrence and mortality risk of cardiovascular disease in patients with type 2 diabetes over the next 10 years.