亚临床甲状腺功能减退对2型糖尿病患者高敏C反应蛋白水平与大血管病变的影响

目的 观察亚临床甲状腺功能减退（SCH）对T2DM患者血清高敏C反应蛋白（hsC-RP）水平及大血管病变的影响. 方法 将328例T2DM患者分为T2DM合并SCH（T2DM＋ SCH）组及单纯T2DM（T2DM）组,测定BMI、WC、促甲状腺激素（TSH）、血清游离甲状腺素（FT4）、血清游离三碘甲腺原氨酸（FT3）、FPG、FC-P、TC、TG、LDL-C、HDL-C、HbA1c、血清hsC-RP水平、颈动脉内-中膜厚度（CI-MT）、颈动脉斑块发生率、踝肱指数（ABI）及评估大血管病变发生率. 结果 T2DM＋ SCH组女性患者比例、BMI、WC、TSH、TC、TG、LDL-C、hsGRP水平均高于T2DM组（P＜0.05）;T2DM＋ SCH组CI-MT增厚,颈动脉斑块、大血管病变发生率增加,高血压病、脑血管病、冠心病患病率均高于T2DM组（57.7％ vs 36.6％、40.4％ vs 25.0％、42.3％ vs 19.2％,P均＜0.05）,而ABI低于T2DM组（P＜0.05）;Logistic回归分析结果显示,SCH是糖尿病大血管病变发生的独立危险因素. 结论 T2DM合并SCH患者颈动脉斑块及大血管病变发生率增加,脂代谢异常及炎性反应参与了颈动脉斑块及大血管病变的形成.

The influence of subclinical hypothyroidism on serum high sensitivity C-reactive protein and macrovascular disease in type 2 diabetic patients

Objective To investigate the influence of subclinical hypothyroidism（SCH） on serum high sensitivity C-reactive protein（hsC-RP） and macrovascular disease in T2DM patients.Methods 328patients with T2DM were divided into T2DM＋SCH group and simple T2DM group.Carotid intima-media thickness（CIMT） and ankle brachial index（ABI） was detected.Atherosclerotic lesions of carotid artery was observed with Doppler ultrsound examination.The levels of BMI,WC,thyroid-stimulating hormone （TSH）,FT4,FT3,FPG,FC P,TC,LDL-C,TG,HDL-C,HbA1c,hsC-RP were measured.Results The serum levels of TSH,TC,TG,LDL-C,hsC-RP,BMI,WC and CIMT were significantly higher in T2DM＋SCH group than those in T2DM group ; The incidence rate of atherosclerotic plaque and macrovascular disease was increased.The prevalence of hypertension,cerebrovascular and cardiovascular disease was higher,but the ABI was lower （P＜ 0.05）,in T2DM＋SCH group than in T2DM group （57.7％ vs 36.6％,40.4％ vs 25.0％,42.3％ vs 19.2％,all P ＜0.05）.Logistic regression analysis demonstrated that SCH was independent risk factor for diabetic macrovascular disease.Conclusion There is a close relationship between SCH and macrovascular disease in T2DM patients,the disturbance of lipid and inflammation is probably involved in development of macrovascular disease in patients with T2DM.