2型糖尿病患者血清Hcy和CysC及Met水平与甲状腺结节发生的相关性分析

Correlation analysis of serum Hcy,CysC and Met with thyroid nodules in patients with type 2 diabetes mellitus

目的检测2型糖尿病(T2DM)患者血清同型半胱氨酸(Hcy)、胱抑素C(Cys-C)、甲硫氨酸(Met)水平,分析其与甲状腺结节的相关性。方法选取2022年1-12月在中国人民解放军联勤保障部队第九六七医院内分泌科收治的T2DM患者116例,根据是否合并甲状腺结节分为甲状腺结节组(n=75)和非甲状腺结节组(n=41)。比较两组患者一般临床资料、生化指标及Hcy、Cys-C、Met水平,并对数据进行统计分析。结果甲状腺结节组Hcy、CysC水平均高于非甲状腺结节组,Met水平低于非甲状腺结节组,差异均有统计学意义(Z=-2.550、-1.973、-2.264,P均<0.05)。Spearman相关性分析显示,Hcy、Cys-C与T2DM合并甲状腺结节均成正相关(r=0.238、0.184,P均<0.05),Met与T2DM合并甲状腺结节成负相关(r=-0.211,P<0.05),Hcy与Cys-C成正相关(r=0.420,P<0.01)。多因素非条件logistic回归分析显示,Hcy和Met分别是T2DM发生甲状腺结节患病风险的独立危险因素和保护性因素(OR=1.247、0.896,P均<0.05)。受试者工作特征(ROC)曲线分析显示,Hcy、Met预测甲状腺结节的曲线下面积(AUC)分别为0.644(95%CI:0.543~0.745,P<0.05)、0.627(95%CI:0.520~0.735,P<0.05),Hcy、Met预测诊断T2DM合并甲状腺结节的最佳截断值分别为12.02、23.57μmol/L,联合检测诊断T2DM合并甲状腺结节的预测价值最高,AUC为0.706(95%CI:0.609~0.803,P<0.01)。结论T2DM患者甲状腺结节的发生与Hcy、Cys-C、Met水平密切相关,Hcy、Met可能是T2DM发生甲状腺结节的独立预测因素,联合检测对T2DM发生甲状腺结节具有较高的预测价值。

Objective To investigate the correlation between serum homocysteine(Hcy),cystatin C(Cys⁃C),methionine(Met)and thyroid nodules in patients with type 2 diabetes mellitus(T2DM).Methods A total of 116 patients with T2DM admitted to the Department of Endocrinology,967th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January to December 2022 were selected and divided into thyroid nodule group(n=75)and non⁃thyroid nodule group(n=41)according to whether there were thyroid nodules.The general clinical data,biochemical indexes,Hcy,Cys⁃C and Met levels of the two groups were compared,and the data were statistically analyzed.Results The levels of Hcy and Cys⁃C in the thyroid nodule group were higher than those in the non⁃thyroid nodule group,and the Met level was lower than that in the non⁃thyroid nodule group,and the differences were statistically significant(Z=-2.550,-1.973,-2.264;all P<0.05).Spearman correlation analysis showed that Hcy and Cys⁃C were positively correlated with T2DM with thyroid nodules(r=0.238,0.184;all P<0.05),Met was negatively correlated with T2DM with thyroid nodules(r=-0.211,P<0.05),and Hcy was positively correlated with Cys⁃C(r=0.420,P<0.01).Multivariate unconditional logistic regression analysis showed that Hcy and Met were independent risk factors and protective factors for the risk of thyroid nodules in T2DM,respectively(OR=1.247,0.896;all P<0.05).The analysis of receiver operating characteristics(ROC)curve showed that the area under the curve(AUC)of Hcy and Met in predicting thyroid nodules were 0.644(95%CI:0.543-0.745,P<0.05)and 0.627(95%CI:0.520-0.735,P<0.05),respectively,and the best cut⁃off values of Hcy and Met in predicting the diagnosis of T2DM complicated with thyroid nodules were 12.02 and 23.57μmol/L,and the predictive value of combined detection in the diagnosis of T2DM complicated with thyroid nodules was the highest,AUC was 0.706(95%CI:0.609-0.803,P<0.01).Conclusion The occurrence of thyroid nodules in patients with T2DM was closely related to the levels of Hcy,Cys⁃C and Met;Hcy and Met might be independent predictors of thyroid nodules in T2DM,and the combined detection has a high predictive value for the development of thyroid nodules in T2DM.