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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

来自:中国糖尿病杂志  编辑:刘红 林小红|点击数:|2014-07-30

·糖尿病与大血管病变·

  【摘要】 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、颈动脉内膜中层厚度(IMT)、颈动脉斑块发生率、肱踝指数(ABI)及大血管病变发生率评估。 结果 T2DM+SCH组女性患者比例、BMI、WC、TSH、TC、TG、LDL-C、hsC-RP水平均高于T2DM组(P<0.05);T2DM+SCH组IMT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明显降低(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患者颈动脉斑块发生率及大血管病变发生率增加,脂代谢紊乱及炎性反应参与了颈动脉斑块及大血管病变的形成。

  【关键词】 糖尿病,2型;亚临床甲状腺功能减退;高敏C反应蛋白;颈动脉内膜中层厚度;肱踝指数

  【Abstract】 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 328 patients with T2DM were divided into T2DM+SCH group and simple T2DM group. Intima-media thickness(IMT) 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,hs-CRP, BMI, WC and IMT 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.

  【Key words】 Diabetes mellitus ,type 2;Subclinical Hypothyroidism;hsC-RP;Intima-media thickness;Ankle brachial index

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