2型糖尿病患者TSH水平与颈动脉粥样硬化的相关性分析

Relationship between TSH and carotid artery atherosclerosis in type 2 diabetes mellitus patients

目的探讨亚临床甲状腺功能减退以及甲状腺功能正常的2型糖尿病患者其TSH水平与颈动脉粥样硬化之间的关系。方法自2011年10月~2013年10月胜利油田中心医院进行'卫生部脑卒中筛查与防治工程',选择1040例2型糖尿病患者进行回顾性分析。检查项目包括甲状腺功能、颈动脉超声、甘油三酯、低密度脂蛋白胆固醇、同型半胱氨酸等,记录患者的一般资料并进行相关数据分析。结果经过年龄等因素校正后,2型糖尿病合并亚临床甲状腺功能减退组的颈动脉内-中膜厚度大于甲状腺功能正常组,斑块个数及低回声斑块所占比例及狭窄≥30%比例高于甲状腺功能正常组。TSH轻度增高的2型糖尿病患者组(4.81~9.9m IU/L)斑块个数、低回声斑块所占比例高于甲状腺功能正常组。在超重的2型糖尿病人群中(体重指数≥24.0 kg/m2),TSH同斑块个数,低回声斑块,颈动脉内-中膜厚度呈正相关,且经过年龄、性别、甘油三酯、胆固醇、同型半胱氨酸等因素进行校正后,这种相关性仍然存在。结论 2型糖尿病患者中,亚临床甲状腺功能减退是颈动脉粥样硬化的危险因素;TSH轻度增高是形成不稳定斑块的危险因素;超重的2型糖尿病患者中TSH为动脉粥样硬化的危险因素,且独立于年龄、血脂等因素。

Objective To investigate the relationship between TSH and carotid atherosclerosis in type 2 diabetes mellitus patients with normal thyroid function and subclinical hypothyroidism(SCH). Methods From October 2012 to October 2013,'stroke screening and prevention programs of Ministry of Health 'were conducted in Shengli Oilfield Central Hospital. 1040 cases with type 2 diabetes mellitus were selected to retrospectively analyze. Patients were checked on thyroid function,carotid artery ultrasound,triglyceride,low density lipoprotein cholesterol,homocysteine and so on,general clinical data of patients were recorded. Results After age and other factors were adjusted,carotid artery intima-media thickness of the SCH group was larger than that of euthyroid group,the number of plaques and proportion of low echo plaques and the stenosis ≥30% were higher than those of euthyroid group. The number of plaques and proportion of low echo plaques of group whose TSH increased slightly(4. 81 ~ 9. 9 m IU / L) were higher than those of euthyroid group. In overweight type 2 diabetes mellitus patients(BMI≥24. 0 kg / m2),TSH was positively correlated with number of plaques,low echo plaque,carotid artery intima-media thickness,and after adjustment for age,sex,triglyceride,cholesterol,homocysteine and other factors,this relationship also existed. Conclusion Patients with type 2 diabetes mellitus,SCH is a risk factor of carotid atherosclerosis; TSH increased slightly as a risk factor of the formation of unstable plaques; overweight patients with type 2 diabetes mellitus,TSH is a risk factor of atherosclerosis,and it is independent of age,blood lipid and other factors.