Study on correlation between thyroid hormone levels and cardiac function in type 2 diabetes mellitus patients

doi:10.16138/j.1673-6087.2024.02.02

Abstract

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

CLC Number:

R587

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.

Figures/Tables 6

Table 1

Comparison of basic data between male and female groups [$\bar{x} \pm s$/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

Table 1

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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