老年2型糖尿病患者颅内动脉粥样硬化与亚临床甲状腺功能减退的关系

目的探讨老年2型糖尿病(T2DM)患者颅内动脉粥样硬化与亚临床甲状腺功能减退(SCH)的相关性。方法选择老年T2DM患者404例,其中甲状腺功能正常组(甲功正常组)291例,SCH组113例,比较2组一般情况及各生化指标的差异。分析促甲状腺激素(TSH)与各临床指标的相关性。结果 SCH组女性、颅内动脉粥样硬化、TC、TG、LDL-C、脂蛋白(a)、纤维蛋白原、C反应蛋白、血尿酸、同型半胱氨酸较甲功正常组明显升高,空腹血糖(6.03±1.32)mmol/L vs(7.61±0.93)mmol/L]、HDL-C(1.25±0.46)mmol/L vs(1.41±0.49)mmol/L]、D-二聚体(0.23±0.11)mg/L vs(0.55±0.27)mg/L]显著降低(P<0.05)。TSH、年龄、收缩压、LDL-C、纤维蛋白原、血尿酸、同型半胱氨酸是颅内动脉粥样硬化独立的危险因素,且TSH与纤维蛋白原、TC、TG、LDL-C、脂蛋白(a)、C反应蛋白、血尿酸、同型半胱氨酸呈正相关,与空腹血糖、D-二聚体、HDL-C呈负相关(P<0.05)。结论老年T2DM合并SCH发生颅内动脉粥样硬化风险增加,高TSH是T2DM患者颅内动脉粥样硬化的独立危险因素。

Association between intracranial atherosclerosis and subclinical hypothyroidism in elderly T2DM patients

Objective To study the association between intracranial atherosclerosis and SCH in elderly T2 DM patients.Methods Four hundred and four elderly T2 DM patients were divided into normal thyroid function group(n=291)and SCH group(n=113).Their general conditions and biochemical test findings were compared.Correlation between TSH and different clinical findings was analyzed.Results The incidence of intracranial atherosclerosis,the proportion of female patients,the serum levels of TC,TG,LDL-C,lipoprotein(a),fibrinogen,CRP,uric acid and homocysteine were significantly higher while the serum levels of fasting blood glucose,HDL-C,and D-dimer were significantly lower in females of SCH group than in males of SCH group(P<0.05).Multivariate stepwise logistic regression analysis showed that advanced age,systolic blood pressure,high serum levels of TSH,LDL-C,fibrinogen,uric acid and homocysteine were the independent risk factors for intracranial atherosclerosis.The serum TSH level was positively related with the serum levels of TC,TG,LDL-C,lipoprotein(a),fibrinogen,CRP,uric acid and homocysteine,and negatively correlated with the serum levels of HDL-C,fasting blood glucose,and D-dimer in elderly T2 DM patients(P<0.05).Conclusion The risk to develop intracranial atherosclerosis increases in elderly T2 DM patients with SCH.High serum TSH level is the independent risk factor for intracranial atherosclerosis in elderly T2 DM patients.