亚临床甲状腺功能减退症对糖尿病心脏自主神经病变的影响研究

Association between Subclinical Hypothyroidism and Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus

背景糖尿病心脏自主神经病变(DCAN)是糖尿病常见且严重的慢性并发症之一,但目前关于甲状腺功能与DCAN关系的研究报道较少。目的探讨亚临床甲状腺功能减退症(SCH)对DCAN的影响。方法选取2019年10月至2020年10月在首都医科大学附属北京友谊医院住院及门诊就诊的2型糖尿病患者564例。所有患者均完成Ewing试验。收集患者一般资料、体格检查结果、实验室检查结果,并依据Ewing试验评估并筛查DCAN。相关性分析采用Pearson相关分析和Spearman秩相关分析,采用多因素Logistic逐步回归分析探究2型糖尿病患者并发DCAN的影响因素。结果564例2型糖尿病患者中,129例并发DCAN(DCAN组),435例未并发DCAN(对照组),DCAN发生率为22.9%。2型糖尿病患者中合并SCH者84例(14.9%),DCAN组患者中合并SCH者36例(28.0%),对照组患者中合并SCH者48例(11.0%),DCAN组患者合并SCH患病率高于对照组(χ^(2)=22.346,P<0.001)。2型糖尿病并发DCAN患者Valsalva试验动作期间最大R-R间距与最小R-R间距比值(VAL R-R比值)与糖尿病病程、糖化血红蛋白(HbA;)、空腹血糖(FBG)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TC)、超敏C反应蛋白(hs-CRP)、促甲状腺激素(TSH)、尿微量白蛋白/肌酐(UACR)呈负相关,与舒张压(DBP)呈正相关(P<0.05)。多因素Logistic逐步回归分析结果显示,SCH〔OR=1.717,95%CI(1.246,2.365)〕是2型糖尿病患者并发DCAN的独立影响因素(P<0.05)。结论2型糖尿病患者TSH水平与DCAN相关,且SCH是2型糖尿病患者并发DCAN的独立影响因素。

Background Cardiac autonomic neuropathy(CAN)is a common and severe chronic diabetic complication,whose association with thyroid function has rarely been reported.Objective To investigate the association between subclinical hypothyroidism and CAN in type 2 diabetes mellitus(T2DM).Methods We performed a retrospective analysis of 564 outpatients and hospitalized patients with T2DM recruited from Beijing Friendship Hospital,Capital Medical University from October 2019 to October 2020.Baseline characteristics,physical and laboratory examination results were collected.Ewing test was performed to identify CAN.The association between subclinical hypothyroidism and CAN was assessed using the Pearson correlation coefficient and Spearman’s rank coefficient of correlation.Factors associated with CAN in T2DM were identified using multivariate,stepwise logistic regression.Results One hundred and twenty-nine subjects(22.9%)were found with CAN,and other 435 without.Subclinical hypothyroidism was detected in 84 cases(14.9%),including 36 with CAN and 48 without.The prevalence of subclinical hypothyroidism in those with CAN〔28.0%(36/129)〕was higher than that of those without〔11.0%(48/435)〕(χ^(2)=22.346,P<0.001).For those with CAN,the ratio between maximum and minimum R-R intervals during the Valsalva maneuver demonstrated a negative correlation with the duration of T2DM,glycated hemoglobin,fasting plasma glucose,low-density lipoprotein cholesterol,triacylglycerol,high-sensitivity C-reactive protein,thyroid-stimulating hormone and urine albumin-to-creatinine ratio,while it demonstrated a positive correlation with the diastolic blood pressure(P<0.05).The multivariate,stepwise logistic regression analysis revealed that subclinical hypothyroidism〔OR=1.717,95%CI(1.246,2.365)〕was independently associated with increased risk of CAN in T2DM(P<0.05).Conclusion In type 2 diabetes patients,the level of TSH may be related to CAN,and subclinical hypothyroidism may be an independent associated factor of CAN.