甲状腺激素敏感性指标与甲状腺功能正常的T2DM患者轻微认知功能障碍的关系  

Relationship between thyroid hormone sensitivity indicators and mild cognitive impairment in patients with type 2 diabetes mellitus who have normal thyroid function

作　　者：王龙龙 孙艺娟 李艳妮 Wang Longlong;Sun Yijuan;Li Yanni(Department of Laboratory Medicine,Shangluo Central Hospital,Shangluo 726000,Shaanxi Province,China)

机构地区：[1]商洛市中心医院医学检验科,商洛726000

出　　处：《中国基层医药》2025年第1期14-20,共7页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨甲状腺功能正常的2型糖尿病(T2DM)患者甲状腺激素敏感性指标与轻微认知功能障碍(MCI)风险之间的关系。方法采用回顾性研究设计,收集2022年6月至2024年1月在商洛市中心医院收治的甲状腺功能正常的T2DM患者100例,分别采用简易精神状况检查表(MMSE)、蒙特利尔认知评估量表(MoCA)评估,将MMSE≤26分或MoCA≤26分纳入MCI组(MCI,n=22),将MMSE>26分且MoCA>26分纳入非MCI组(非认知功能障碍组,n=78),多因素logistic回归分析T2DM患者MCI的影响因素,受试者工作特征曲线(ROC)分析甲状腺激素敏感性指标对T2DM患者MCI的预测价值。结果MCI组受教育程度高中及以下占比68.18%、糖化血红蛋白(HbA1c)(8.45±1.95)%、胰岛素抵抗指数(HOMA-IR)(3.34±0.25)、三酰甘油(TG)(2.59±0.19)mmol/L、尿酸(UA)(354.76±46.16)μmol/L、促甲状腺激素指数(TSHI)(3.09±0.26)、甲状腺反馈quantile-based指数(TFQI)[0.2(0.0,0.5)]分别高于非MCI组43.59%、(7.63±1.61)%、(3.05±0.17)、(2.09±0.15)mmol/L、(311.74±67.15)μmol/L、(2.87±0.13)、[0.2(-0.1,0.4)](χ^(2)=4.15,t=2.01、6.32、12.99、3.47、5.47、Z=-2.54,均P<0.05),MCI组游离三碘甲状腺原氨酸(FT3)(4.32±0.21)pmol/L、促甲状腺素T4阻力指数(TT4RI)(34.54±4.30)低于非MCI组(4.61±0.36)pmol/L、(37.15±5.55)(t=2.58、2.04,均P<0.05)。两组在其他方面如性别、年龄、身体质量指数(BMI)、饮酒、吸烟、脑梗死、高血压、糖尿病病程、仅口服二甲双胍、空腹血糖(FBG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、游离甲状腺素(FT4)、甲状腺刺激素(TSH)比较,差异均无统计学意义(均P>0.05);logistic回归分析显示,受教育程度、TG、尿酸、FT3、TSHI、TT4RI均为T2DM患者发生MCI的影响因素(均P<0.05);甲状腺激素敏感性指标联合预测T2DM患者MCI价值更高,曲线下面积(AUC)为0.778[95%CI(0.676,0.880),P<0Objective To investigate the relationship between thyroid hormone sensitivity indicators and the risk of mild cognitive impairment(MCI)in patients with type 2 diabetes mellitus(T2DM)who have normal thyroid function.Methods A retrospective study design was used to gather data from 100 patients with T2DM who had normal thyroid function and were treated at Shangluo Central Hospital between June 2022 and January 2024.The Mini-Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA)were used for evaluation.Patients with an MMSE score of≤26 or a MoCA score of≤26 were included in the MCI group(n=22),whereas those with an MMSE score of>26 and a MoCA score of>26 were included in the non-MCI group(n=78).Multivariate logistic regression analysis was performed to identify factors influencing MCI in patients with T2DM.Additionally,receiver operating characteristic curve analysis was conducted to assess the predictive value of thyroid hormone sensitivity indicators for MCI in this patient population.Results In the MCI group,68.18%of patients had an education level of high school or below.The level of glycosylated hemoglobin in this group was(8.45±1.95)%,insulin resistance index was(3.34±0.25),the level of triglycerides was(2.59±0.19)mmol/L,the level of uric acid was(354.76±46.16)μmol/L,thyroid-stimulating hormone index was(3.09±0.26),and thyroid feedback quantile-based index was[0.2(0.0,0.5)].All of these values were significantly higher than those in the non-MCI group:[43.59%,(7.63±1.61)%,(3.05±0.17),(2.09±0.15)mmol/L,(311.74±67.15)μmol/L,(2.87±0.13),0.2(-0.1,0.4),χ^(2)=4.15,t=2.01,6.32,12.99,3.47,5.47,Z=-2.54,all P<0.05].In the MCI group,the level of free triiodothyronine was(4.32±0.21)pmol/L,and thyrotroph T4 resistance index(TT4RI)was(34.54±4.30),both of which were significantly lower than those in the non-MCI group[(4.61±0.36)pmol/L,(37.15±5.55),t=2.58,2.04,both P<0.05].There were no significant differences in gender,age,body mass index,alcohol consumption,smoking,history of cerebral

关 键 词：糖尿病 2型 甲状腺功能试验 甲状腺素 三碘甲状腺原氨酸 血红蛋白A 糖基化 认知功能障碍 预测 

分 类 号：R58[医药卫生—内分泌]