诊断学理论与实践 ›› 2024, Vol. 23 ›› Issue (02): 155-161.doi: 10.16150/j.1671-2870.2024.02.009
收稿日期:
2023-11-23
出版日期:
2024-04-25
发布日期:
2024-07-04
通讯作者:
沈琳辉 E-mail: linhui_shen@163.com基金资助:
MIAO Jie, WANG Wei, ZHAO Yajie, ZHANG Fengru, SHEN Linhui()
Received:
2023-11-23
Published:
2024-04-25
Online:
2024-07-04
摘要:
目的:探讨2型糖尿病(type 2 diabetes mellitus, T2DM)老年男性患者的甲状腺激素水平与其左心室舒张功能不全(left ventricular diastolic dysfunction, LVDD)间的相关性。方法:选取2020年1月至2021年11月在我院老年病科住院的208例老年男性T2DM患者(≥60岁),根据超声心动图组织多普勒及血流多普勒结果,参照2020年《超声心动图评估心脏收缩和舒张功能临床应用指南》将其分为LVDD组(112例)和左心室舒张功能正常对照组(对照组,96例),比较2组间的基线资料、甲状腺激素水平、超声心动图指标。再根据游离三碘甲状腺原氨酸(free triiodothyronine, FT3)四分位数水平,将全部患者分为F1组(2.43 pmol/L<FT3≤3.30 pmol/L,52例)、F2组(3.31 pmol/L<FT3≤3.78 pmol/L, 52例)、F3组(3.79 pmol/L<FT3≤4.65 pmol/L, 52例)、F4组(4.66 pmol/L<FT3≤6.01 pmol/L,52例),比较4组间的基线资料和超声心动图指标。采用Pearson相关分析观察FT3与超声指标间的相关性,用多因素logistic回归分析FT3与LVDD间的关系,绘制受试者工作特征(receiver operating characteristic, ROC)曲线,评估FT3和logistic回归模型诊断LVDD的效能。结果:老年男性T2DM患者中,LVDD组较对照组FT3水平降低[(3.51±0.24) pmol/L比(4.72±0.33) pmol/L, P<0.01]。根据FT3水平四分位数分组,4组间的LVDD百分比(P<0.01)、超声心动图参数二尖瓣口舒张早期血流峰值速度E峰与二尖瓣环舒张早期运动峰值速度e’峰比值(E/e’)(P<0.01)差异均有统计学意义。Pearson相关分析显示,FT3水平与E/e’、左房最大容积指数(left atrial volume index,LAVI)呈显著负相关(P均<0.001)。多因素Logistic回归分析显示,随着老年男性T2DM患者的FT3水平递减,其发生LVDD的风险逐渐增加(F3组OR=2.29;F2组OR=3.36;F1组OR=4.95,P均<0.05)。年龄、糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平、糖尿病病程、FT3水平进入Logistic回归分析模型,ROC曲线分析显示,FT3和Logistic回归分析模型诊断LVDD的曲线下面积为0.742和0.858;FT3的临界值取3.37 pmol/L时,其提示患者出现LVDD的灵敏度为66.2%,特异度为75.0%。结论:老年男性T2DM患者的FT3水平降低时,LVDD风险上升,检测FT3可能有助于早期筛查LVDD。
中图分类号:
缪婕, 王巍, 赵雅洁, 张凤如, 沈琳辉. 老年男性2型糖尿病患者游离三碘甲状腺原氨酸水平与左心室舒张功能不全相关[J]. 诊断学理论与实践, 2024, 23(02): 155-161.
MIAO Jie, WANG Wei, ZHAO Yajie, ZHANG Fengru, SHEN Linhui. The correlation between free T3 level and left ventricular diastolic dysfunction in elderly male patients with T2DM[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(02): 155-161.
表1
LVDD组与左心室舒张功能正常组一般情况、超声心动图指标、甲状腺激素比较
Indice | LVDD (112) | Control (96) | P value |
---|---|---|---|
General characteristics | |||
Age(year) | 78.1±2.8** | 72.5±1.8 | <0.010 |
Duration of diabetes mellitus(y) | 10.2±3.2* | 7.7±2.8 | 0.038 |
Hypertension(n,%) | 82,73.2 | 70,72.9 | 0.836 |
Insulin treatment(n,%) | 35,31.3 | 32,33.3 | 0.721 |
BMI(kg/m2) | 24.8±2.7 | 23.6±4.8 | 0.649 |
HbA1c(%) | 7.7±0.4** | 6.8±0.2 | <0.010 |
FPG(mmol/L) | 7.3±0.6 | 6.8±0.8 | 0.582 |
TC(mmol/L) | 4.82±0.41 | 4.57±0.36 | 0.748 |
TG(mmol/L) | 1.69±0.22 | 1.57±0.37 | 0.681 |
LDL-C(mmol/L) | 3.23±0.45 | 3.18±0.51 | 0.768 |
HDL-C(mmol/L) | 0.99±0.15 | 1.04±0.22 | 0.629 |
Pro-BNP(pg/mL) | 309±27 | 295±30 | 0.436 |
Echocardiogram parameters | |||
LAVI(mL/m2) | 36.1±0.5* | 28.8±0.4 | 0.025 |
E/e’ | 14.8±2.1** | 7.2±1.9 | <0.010 |
LVEF(%) | 68.2±3.1 | 70.1±2.9 | 0.642 |
LVMI(g/m2) | 75.2±9.2 | 73.5±10.1 | 0.421 |
Thyroid hormone | |||
FT3(pmol/L) | 3.51±0.24** | 4.72±0.33 | <0.010 |
FT4(pmol/L) | 14.56±1.98 | 13.98±2.06 | 0.591 |
sTSH(μIU/mL) | 3.584±0.954 | 3.285±1.128 | 0.728 |
表2
老年男性T2DM患者LVDD的多因素logistic回归分析
Indice | OR value(95% CI) | Pvalue |
---|---|---|
Age | 1.21(1.09~1.34) | 0.034 |
Duration of diabetes mellitus | 1.08(0.99~1.12) | 0.045 |
HbA1c | 1.32(1.08~1.71) | 0.027 |
FT3 | 2.66(1.09~4.11) | 0.001 |
F4 quartile group | 1.00 | |
F3 quartile group | 2.29(1.43~3.29) | 0.036 |
F2 quartile group | 3.36(1.78~5.21) | 0.012 |
F1 quartile group | 4.95(2.12~7.65) | 0.001 |
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