2型糖尿病患者甲状腺激素水平与心功能的相关性研究

doi:10.16138/j.1673-6087.2024.02.02

摘要/Abstract

摘要：

目的：探讨2型糖尿病(type 2 diabetes mellitus， T2DM)患者参考范围内的甲状腺激素水平对心功能和结构的影响。方法：收集甲状腺激素水平正常的T2DM患者526例，记录年龄、病程，测量血压，检测血糖、血脂、肝功能、肾功能和甲状腺激素水平；彩色超声诊断仪分析心脏结构和功能。结果：526例T2DM患者中，女性患者的总胆固醇(total cholesterol， TC)、低密度脂蛋白胆固醇(low density lipoproteincholesterol， LDL-C)、高密度脂蛋白胆固醇(high density lipoproteincholesterol， HDL-C)、左室射血分数(left ventricular ejection fraction， LVEF)、促甲状腺激素(thyroid stimulating hormone， TSH)均高于男性患者（均P<0.05），身高、体重、血红蛋白(hemoglobin，Hb)、血尿素氮(blood urea nitrogen， BUN)、血肌酐(creatinine， Cr)、血尿酸 (uric acid，UA)、左房内径(left atrial diameter， LAD)、室间隔厚度(interventricular septum thickness， IVST) 、左室舒张末期内径 (left ventricular end diastolic diameter, LVEDD)、左室后壁厚度(left ventricular posteriorwall thickness， LVPWT)、左室收缩末期内径(left ventricular end systolic diameter, LVESD)、主动脉根部内径(aortic root diameter， AORD)、游离甲状腺素(free thyroxine 4， FT₄)、游离三碘甲腺原氨酸(triiodothyronine， FT₃)均低于男性患者（均P<0.05）。相关分析显示，在总体人群中，FT₃与LVPWT、LVESD、AORD呈正相关（均P<0.05）；男性组中，TSH与LVESD呈正相关；女性组中，FT₃与LAD、LVESD呈正相关，FT₄与LVEF呈负相关（P<0.05）。多元线性回归分析，对于女性患者，FT₃是LVESD的独立于年龄、糖尿病病程、BMI、糖化血红蛋白、舒张压、收缩压的相关因素（P<0.05）。结论：对于甲状腺激素在参考范围内的T2DM患者，随着FT₃的增加，LVPWT增加，LVESD增加。女性患者FT₃与心脏结构独立正相关。T2DM患者的甲状腺激素水平即使在参考范围内，也可能对心脏产生影响。

关键词: 甲状腺激素, 心功能, 心脏结构, 2型糖尿病

Abstract:

Objective To determine the relationship between thyroid hormones levels and cardiac function and structure in type 2 diabetes mellitus (T2DM) patients with normal thyroid function. Methods Totally 526 cases of T2DM patients with normal thyroid function were enrolled, and their information including gender, age, course of disease, blood pressure, blood lipids, liver and kidney functions, and thyroid function were collected; Color diagnostic ultrasound equipment was used to analyze the structure and function of the heart. Results Compared with the male group, the indexes including total cholesterol(TC), high density lipoproteincholesterol (HDL-C), low density lipoproteincholesterol(LDL-C), left ventricular ejection fraction(LVEF）, and thyroid stimulating hormone(TSH) were significantly higher in the female group, while the indexes including height, weight, hemoglobin（Hb）, blood urea nitrogen（BUN）, creatinine(Cr), uric acid(UA), left atrial diameter (LAD), interventricular septum thickness(IVST), left ventricular end diastolic diameter (LVEDD), left ventricular posteriorwall thickness(LVPWT), left ventricular end systolic diameter(LVESD), aortic root diameter(AORD), free triiodothyronine(FT₃), and free thyroxine(FT₄) were significantly lower in the female group (all P<0.05). Correlation analysis showed that FT₃ was positively correlated with LVPWT, LVESD and AORD in the general population (all P<0.05 ). In the male group, TSH was positively correlated with LVESD; in female group, FT₃ was positively correlated with LAD and LVESD, and FT₄ was negatively correlated with LVEF(P<0.05). Multiple linear regression analysis showed that for female patients, FT₃ was an independent fact of LVESD, as the other independents factors, which were age, duration of diabetes, body mass index (BMI), glycosylated hemoglobin, diastolic blood pressure and systolic blood pressure. Conclusions For T2DM patients with normal thyroid function, as the increase of circulating thyroid hormones, LVPWT and LVESD increase. Multiple regression analysis showed that FT₃ was independently and positively correlated with cardiac structure in female patients. These results indicate that thyroid hormone levels in patients with T2DM might have an impact on the heart changes even if they are within the normal range.

Key words: Thyroid hormones, Cardiac function, Heart structure, Type 2 diabetes mellitus

中图分类号:

R587

陈俊秀, 石群, 秦利, 吴一鸣. 2型糖尿病患者甲状腺激素水平与心功能的相关性研究[J]. 内科理论与实践, 2024, 19(02): 95-101.

CHEN Junxiu, SHI Qun, QIN Li, WU Yiming. Study on correlation between thyroid hormone levels and cardiac function in type 2 diabetes mellitus patients[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(02): 95-101.

图/表 6

表1

男性、女性2组基本资料比较[$\bar{x} \pm s$/n(%)/M(Q1,Q3)]

项目	男性（n=298）	女性（n=228）	t/Z/χ²	P
年龄（岁）	58.00(50.75,65.00)	60.00(54.00,65.00)	-1.953	0.051
糖尿病病程（月）	98.42±5.35	105.87±5.77	-0.938	0.349
舒张压（mmHg）	79.15±10.69	78.26±11.3	0.929	0.353
收缩压（mmHg）	134.75±20.06	138.00±18.67	-1.896	0.058
心率（次/min）	84(75,91)	83(76,91)	-0.340	0.734
身高（cm）	169.00(164.50,173.5)	157.00(154.00,160.00)	-16.413	<0.001
体重（kg）	71.05(64.68,78.93)	61.75(56.00,69.40)	-9.190	<0.001
BMI（kg/m²）	24.90(23.00,27.30)	25.05(22.73,27.75)	-0.220	0.826
内脏脂肪（cm²）	86.00(56.20,120.00)	79.00(51.35,104.95)	-1.400	0.161
皮下脂肪（cm²）	165.00(123.70,212.00)	176(141.45,219.70)	-1.614	0.107
HbA_1c（%）	10(9,11)	10(9,12)	-1.184	0.237
Hb (g/L）	149(141,159)	137(126,145)	-10.059	<0.001
ALT (U/L)	14(9,20)	12(8,19)	-1.446	0.148
AST (U/L)	20.00(14.00,27.00)	21.00(14.00,28.50)	-1.116	0.264
BUN（mmol/L）	6.30(5.10,7.60)	5.65(4.60,6.88)	-3.837	<0.001
Cr (μmol/L)	66.00(57.00,82.25)	48.50(40.00,60.00)	-10.913	<0.001
UA (μmol/L)	310(260,390)	260(220,350)	-6.150	<0.001
TG (mmol/L)	1.52(0.96,2.59)	1.43(1.01,2.01)	-0.947	0.344
TC (mmol/L)	4.96(4.01,5.88)	5.22(4.57,6.22)	-3.393	0.001
HDL-C (mmol/L)	1.46(1.22,1.80)	1.73(1.34,2.06)	-4.793	<0.001
LDL-C (mmol/L)	2.94±1.01	3.22±1.07	-3.066	0.002
FT₃（pmol/L）	4.73(4.32,5.15)	4.48(4.14,4.84)	-4.538	<0.001
FT₄（pmol/L）	17.78±6.68	16.70±2.46	2.316	0.021
TSH (mU/L)	1.66(1.14,2.32)	2.01(1.30,2.84)	-3.360	0.001
LAD (mm)	34(32,36)	32(30,34)	-6.535	<0.001
IVST (mm)	10(10,10)	10(9,10)	-3.907	<0.001
LVEDD (mm)	48.00(45.00,50.00)	45.00(42.25,48.00)	-7.120	<0.001
LVPWT (mm)	10(10,10)	10(9,10)	-5.076	<0.001
LVEF (%)	63(60,67)	65(61,68)	-2.757	0.006
LVESD (mm)	31(29,33)	29(27,31)	-6.546	<0.001
AORD (mm)	32.00(30.00,33.00)	29.00(27.00,31.75)	-8.713	<0.001

表1

表2

表3

表4

表5

表6

参考文献 35

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指标	FT₃		FT₄		TSH
指标	r	P	r	P	r	P
舒张压 (mmHg)	0.155	<0.001	-0.034	0.436	0.044	0.318
收缩压 (mmHg)	0.079	0.070	-0.047	0.277	0.093	0.034
糖尿病病程 (月)	-0.090	0.039	-0.002	0.970	0.008	0.858
年龄(岁)	-0.133	0.087	-0.083	<0.001	0.051	0.005
BMI (kg/m²)	0.187	<0.001	-0.001	0.975	0.084	0.055
HbA_1c(%)	-0.243	<0.001	-0.013	0.764	-0.107	0.014
LAD (mm)	0.064	0.143	0.012	0.780	-0.017	0.705
IVST (mm)	0.067	0.124	0.016	0.711	-0.051	0.245
LVEDD (mm)	0.077	0.079	0.001	0.981	0.034	0.435
LVPWT (mm)	0.098	0.025	0.038	0.389	-0.025	0.561
LVEF (%)	-0.270	0.535	-0.011	0.808	0.052	0.236
LVESD (mm)	0.155	<0.001	0.004	0.932	0.017	0.689
AORD (mm)	0.100	0.022	0.070	0.111	-0.065	0.135

指标	FT₃		FT₄		TSH
指标	r	P	r	P	r	P
舒张压（mmHg）	0.242	<0.001	-0.067	0.250	0.065	0.266
收缩压（mmHg）	0.182	0.002	-0.071	0.225	0.049	0.397
糖尿病病程（月）	-0.067	0.248	0.024	0.674	0.064	0.270
年龄（岁）	-0.259	<0.001	-0.021	0.721	0.084	0.149
BMI（kg/m²)	0.232	<0.001	-0.027	0.641	0.118	0.041
HbA_1c（%）	-0.205	0.002	0.125	0.063	-0.160	0.017
LAD (mm)	0.038	0.509	0.004	0.950	-0.009	0.875
IVST (mm)	0.061	0.297	0.007	0.898	-0.039	0.507
LVEDD (mm)	0.040	0.495	-0.025	0.661	0.079	0.174
LVPWT (mm)	0.075	0.195	0.030	0.604	-0.014	0.811
LVEF (%)	-0.041	0.477	0.036	0.541	-0.018	0.754
LVESD (mm)	0.073	0.208	-0.045	0.442	0.114	0.050
AORD (mm)	0.035	0.548	0.039	0.506	-0.02	0.726

指标	FT₃		FT₄		TSH
指标	r	P	r	P	r	P
舒张压（mmHg）	0.016	0.808	0.040	0.547	0.034	0.614
收缩压（mmHg）	-0.054	0.420	0.065	0.327	0.124	0.061
糖尿病病程（月）	-0.116	0.085	-0.082	0.224	-0.080	0.233
年龄（岁）	-0.056	0.402	-0.092	0.167	0.030	0.650
BMI（kg/m²)	0.120	0.072	0.091	0.173	0.045	0.502
HbA_1c（%）	-0.331	<0.001	0.053	0.493	-0.018	0.812
LAD (mm)	0.154	0.020	-0.045	0.503	0.052	0.433
IVST (mm)	0.024	0.724	-0.010	0.880	-0.045	0.494
LVEDD (mm)	0.022	0.739	-0.049	0.459	0.078	0.239
LVPWT (mm)	0.042	0.524	-0.040	0.551	0.038	0.572
LVEF (%)	0.042	0.527	-0.139	0.036	0.111	0.095
LVESD (mm)	0.178	0.007	0.029	0.660	0.001	0.993
AORD (mm)	0.046	0.491	0.033	0.621	0.003	0.967

指标	β	t	P	VIF	F	R²	Durbin-Watson
年龄（岁）	0.054	0.831	0.407	1.394	6.627	0.118	1.898
糖尿病病程（月）	-0.071	-1.181	0.239	1.200
BMI（kg/m²)	0.28	4.733	<0.001	1.165
HbA_1c（%）	-0.187	-3.162	0.002	1.171
舒张压（mmHg）	0.127	1.637	0.103	2.011
收缩压（mmHg）	-0.07	-0.896	0.371	2.038
FT₃（pmol/L）	-0.043	-0.721	0.472	1.214

指标	β	t	P	VIF	F	R²	Durbin-Watson
年龄（岁）	0.227	3.202	0.002	1.315	6.90	0.158	1.786
糖尿病病程（月）	0.279	4.327	<0.001	1.356
BMI（kg/m²)	0.012	0.162	0.871	1.083
HbA_1c（%）	-0.019	-0.292	0.770	1.127
舒张压（mmHg）	0.031	0.385	0.701	1.685
收缩压（mmHg）	0.054	0.688	0.492	1.639
FT₃（pmol/L）	0.162	2.47	0.014	1.129