甲状腺功能正常的2型糖尿病患者血清促甲状腺激素与颈动脉粥样斑块形成及严重程度的相关性

Correlations of serum thyroid-stimulating hormone with the formation and severity of carotid atheromatous plaque in type 2 diabetes mellitus patients with normal thyroid function

目的探讨甲状腺功能正常的2型糖尿病(T2DM)患者的血清促甲状腺激素(TSH)与颈动脉粥样斑块形成及严重程度的相关性。方法回顾性分析430例甲状腺功能正常的T2DM患者的临床资料,根据入院时颈动脉有无粥样斑块形成分为有斑块组292例与无斑块组138例,再按照颈动脉斑块分级标准将斑块组患者分为3个亚组:Ⅰ级组30例、Ⅱ级组113例、Ⅲ级组149例。比较不同组患者性别、年龄、糖尿病病程、体质指数、收缩压、舒张压,以及血清三酰甘油、总胆固醇、LDL-C、HbA1c、TSH、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))水平的差异。采用Logistic回归模型分析甲状腺功能正常的T2DM患者颈动脉粥样斑块形成及严重程度的影响因素,采用受试者工作特征(ROC)曲线分析血清TSH对甲状腺功能正常的T2DM患者颈动脉粥样斑块形成的预测价值。结果有斑块组与无斑块组患者的年龄、糖尿病病程、收缩压、体质指数、血清三酰甘油水平、血清FT 4水平及血清TSH水平比较,差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示,年龄、糖尿病病程、收缩压、体质指数及血清TSH水平均为甲状腺功能正常的T2DM患者颈动脉粥样斑块形成的独立影响因素(均P<0.05)。Ⅰ级组、Ⅱ级组、Ⅲ级组患者的年龄、糖尿病病程及血清TSH水平比较,差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示,年龄、糖尿病病程及血清TSH水平为甲状腺功能正常的T2DM患者颈动脉粥样斑块严重程度的独立影响因素(均P<0.05)。ROC曲线分析结果显示,血清TSH预测甲状腺功能正常的T2DM患者颈动脉粥样斑块形成的曲线下面积为0.621(95%CI:0.029,0.690;P<0.05),最佳截断值为1.645 mU/L,灵敏度为63.4%,特异度为55.1%。结论正常范围内较高水平的血清TSH是甲状腺功能正常的T2DM患者颈动脉粥样斑块形成与严重程度加重的独立危险因素,对于血清TSH水平为1.645 mU/L及以上的甲状腺功能正常的T2DM患者,应密切关注其有无颈动脉粥样斑块形成,或及时干预以减缓斑块的发展。

Objective To investigate the correlations of serum thyroid-stimulating hormone(TSH)with the formation and severity of carotid atheromatous plaque in type 2 diabetes mellitus(T2DM)patients with normal thyroid function.Methods The clinical data of 430 T2DM patients with normal thyroid function were retrospectively analyzed,and they were assigned to plaque group(292 cases)or non-plaque group(138 cases)according to the presence of carotid atheromatous plaque formation at admission,and then patients in the plaque group were further assigned to 3 subgroups according to carotid plaque classification standard as follows:gradeⅠgroup(30 cases),gradeⅡgroup(113 cases),or gradeⅢgroup(149 cases).The differences in gender,age,diabetic disease course,body mass index,systolic pressure,diastolic pressure,and levels of serum triglyceride,total cholesterol,LDL-C,HbA1c,TSH,free triiodothyronine(FT_(3)),free thyroxine(FT_(4))of patients were compared between the various groups.The influencing factors for carotid atheromatous plaque formation and severity in T2DM patients with normal thyroid function were analyzed by employing the Logistic regression model.The prediction value of serum TSH on carotid atheromatous plaque formation in T2DM patients with normal thyroid function was analyzed by using the receiver operating characteristic(ROC)curve.Results There were statistically significant differences in age,diabetic disease course,systolic pressure,body mass index,and levels of serum triglyceride,FT 4,and TSH between the plaque group and the non-plaque group(all P<0.05).The results of Logistic regression analysis revealed that age,diabetic disease course,systolic pressure,body mass index,and serum TSH level were the independent influencing factors for carotid atheromatous plaque formation in T2DM patients with normal thyroid function(all P<0.05).There were statistically significant differences in age,diabetic disease course,and serum TSH level of patients between the gradeⅠgroup,the gradeⅡgroup,and the gradeⅢgroup(all P<0.05).The results of Logistic regression analysis implied that age,diabetic disease course,and serum TSH level were the independent influencing factors for the severity of carotid atheromatous plaque in T2DM patients with normal thyroid function(all P<0.05).The results of ROC curve analysis interpreted that the area under the curve of serum TSH in predicting carotid atheromatous plaque formation in T2DM patients with normal thyroid function was 0.621(95%CI:0.029,0.690;P<0.05),the optimal cut-off value was 1.645 mU/L,the sensitivity was 63.4%,and the specificity was 55.1%.Conclusion A higher level of TSH within the normal range is an independent risk factor for the formation and increase in severity of carotid atheromatous plaque in T2DM patients with normal thyroid function.For T2DM patients with normal thyroid function whose serum TSH levels reach 1.645 mU/L and above,close attention should be paid to the presence of carotid atheromatous plaque formation,or timely intervention should be carried out to slow down the progression of plaque.