甲状腺功能减退对老年2型糖尿病患者发生颈动脉粥样硬化的影响及预后评估  

Influence of hypothyroidism on carotid atherosclerosis in elderly patients with type 2 diabetes mellitus and its prognostic value

作　　者：董娟[1] 李悦芃 张任飞[1] 赵籥陶[1] 邱蕾[1] DONG Juan;LI Yuepeng;ZHANG Renfei(Department of Health Care,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院保健医疗部国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《河北医药》2023年第22期3415-3418,共4页Hebei Medical Journal

基　　金：中央保健科研课题(编号:2020YB07)。

摘　　要：目的研究老年2型糖尿病(T2DM)患者颈动脉粥样硬化(CAS)症状受甲状腺功能减退(HT)的影响。方法从2021年3月至2022年3月的老年T2DM患者中随机抽取62例,按照是否存在HT分为A组(未出现HT)和B组(出现HT),每组31例,比较2组性别、CAS、吸烟史、年龄、体重指数(BMI)、糖尿病病程、空腹血糖、糖化血红蛋白(HbA1C)、高血压病程、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)、血小板、凝血酶原时间、活化部分凝血酶原时间(APTT)、纤维蛋白、D-二聚体、C-反应蛋白、血尿酸、同型半胱氨酸、促甲状腺激素(TSH)、游离三碘甲状腺素(FT3)、游离甲状腺素(FT4)。结果2组性别、CAS、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)、纤维蛋白原、C-反应蛋白、血尿酸、同型半胱氨酸、空腹血糖、HDL-C、D-二聚体比较,差异有统计学意义(P<0.05)。老年T2DM患者发生CAS和TSH呈正相关(OR=2.494,95%CI:1.025-6.067,P=0.045);颈动脉狭窄重度组TSH、FT4、FT3、SBP、DBP、BMI、TG、TC、HDL-C、LDL-C、HbA1C与轻度组比较,差异有统计学意义(P<0.05);FT3、HDL-C和颈部动脉狭窄程度呈负相关(rs=-0.287、-0.384,P<0.01),BMI、HbA1c、病程、年龄、LDL-C、TG、TC、SBP、DBP和颈部动脉狭窄程度呈正相关(rs=0.262、0.276、0.164、0.171、0.224、0.284、0.157、0.193、0.142,P<0.05);TSH与生化指标TG、脂蛋白(a)、纤维蛋白原、C-反应蛋白、血尿酸、同型半胱氨酸呈线性关系(P<0.05)。结论老年T2DM患者发生CAS直接受到HT的影响,TSH水平的变化情况能反应CAS的发生和发展情况,因此临床医生要建议老年T2DM患者定期筛查甲状腺功能指标。Objective To analyze the influence of hypothyroidism(HT)on clinical symptoms of carotid atherosclerosis(CAS)in elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 62 elderly T2DM patients randomly selected from March 2021 to March 2022 were divided into group A(31 cases without HT)and group B(31 cases with HT)according to the presence or absence of HT.Sex,CAS,smoking history,age,body mass index(BMI),duration of T2DM,fasting blood glucose(FBG),hemoglobin A1C(HbA1C),duration of hypertension,systolic blood pressure(SBP),diastolic blood pressure(DBP),total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoprotein(a)[Lp(a)],platelet count(PLT),prothrombin time(PT),activated partial prothrombin time(APTT),fibrinogen(FIB),D-dimer(D-D),C-reactive protein(CRP),serum uric acid(UA),homocysteine(Hcy),thyroid stimulating hormone(TSH),free triiodothyronine(FT3),and free thyroxine(FT4)levels were compared between groups.Results There were significant differences in the sex,CAS,TC,TG,LDL-C,Lp(a),FIB,CRP,UA,Hcy,FBG,HDL-C and D-D between groups(P<0.05).The incidence of CAS in elderly T2DM patients was positively correlated with TSH(OR=2.494,95%CI 1.025,6.067,P=0.045).There were significant differences in TSH,FT4,FT3,SBP,DBP,BMI,TG,TC,HDL-C,LDL-C and HbA1C between severe group and mild group of elderly T2DM patients(P<0.05).The degree of stenosis in elderly T2DM patients was negatively correlated with FT3 and HDL-C(rs=-0.287,and-0.384,respectively,both P<0.01),which was positively correlated with BMI,HbA1c,course of disease,age,LDL-C,TG,TC,SBP,and DBP(rs=0.262,0.276,0.164,0.171,0.224,0.284,0.157,0.193,and 0.142,respectively;P<0.05).TSH showed a linear relationship with biochemical indicators of TG,Lp(a),FIB,CRP,UA and Hcy(P<0.05).Conclusion The occurrence of CAS in elderlyT2DM patients is directly affected by HT,and the change in TSH level can reflect the occurrence and development of CAS.Therefore,a regular screening of thyroid functio

关 键 词：甲状腺功能减退 老年 2型糖尿病 颈动脉粥样硬化 

分 类 号：R581.2[医药卫生—内分泌] R587.1[医药卫生—内科学]