【摘要】 目的探讨2型糖尿病(T2DM)患者合并亚临床甲状腺功能减退(SCH)对左心室舒张功能及纤维蛋白原(FIB)的影响。方法选取T2DM患者356例,其中T2DM合并SCH(T2DM+SCH)患者78例,单纯T2DM患者278例。分别测定FIB、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)和临床生化指标,超声心动图测定心室舒张功能。计量资料组间比较采用t检验,相关性分析采用多元线性回归分析。结果 (1)T2DM+SCH组年龄、FIB、CRP均高于单纯T2DM组[(61.09±11.10)岁vs.(58.0±12.38)岁、(3.07±0.77)g/L vs.(2.79±0.72)g/L、(5.54±5.92)mg/L vs.(3.94±3.96)mg/L,P<0.05];空腹及餐后C肽均低于单纯T2DM组[(0.95±0.46)ng/L vs.(1.35±0.77)ng/L,(1.78±1.11)ng/L vs.(3.27±2.67)ng/L,P<0.05]。(2)T2DM+SCH组A峰增加,E/A减小[(93.18±25.37)cm/s vs.(86.85±25.26)cm/s、0.82±0.34 vs.0.94±0.40,P<0.05]。(3)E/A<1组HCY、FIB与TSH值均高于E/A≥1组[(18.42±9.25)mmol/L vs.(15.06±7.07)mmol/L、(3.11±0.91)g/L vs.(2.78±0.71)g/L、(3.43±3.34)m U/L vs.(2.58±1.88)m U/L,P<0.05]。(4)多元回归分析显示病程、舒张压、LDL、HCY、TSH引入男性回归方程(β=-0.732,-0.520,-0.325,-0.395,-0.582,P均<0.05)。病程、收缩压、Hb A1c、TSH引入女性回归方程(β=-0.438,-0.807,-0.462,-0.415,P均<0.05)。结论 T2DM合并SCH患者左心室舒张功能减退,FIB升高可能参与其过程。更多还原

【Abstract】 Objective To assess the effect of left ventricle diastole function and fibrinogen on subclinical hypothyroidism(SCH) in the T2 DM patients. Methods 356 T2 DM patients were enrolled in our study, including 78 T2 DM patients complicated with subclinical hypothyroidism(DSDH group) and 278 T2 DM patients with normal thyroid function group(DNTH group). FIB, FT3, FT4, TSH and other clinical biochemical parameters were measured. Comparison was draw between the two groups by adopting t test. Sex-specific multiple regression models were used to analysis the correlation between thyroid function and cardiac diastolic function. Results(1)The mean age, plasma FIB level, serum CRP level of DSDH group were significantly higher than DNTH group,(61.09±11.10)years vs.(58.0±12.38) years,(3.07±0.77)g/L vs.(2.79±0.72)g/L,(5.54±5.92)mg/L vs.(3.94±3.96)mg/L; P<0.05. Serum fasting and postprandial C-peptide level of DSDH group were significantly lower than DNTH group,(0.95±0.46)ng/L vs.(1.35±0.77)ng/L,(1.78±1.11)ng/L vs.(3.27±2.67)ng/L; all P<0.05. But the BMI, blood pressure, glycated hemoglobin, lipids, liver and kidney function had no significant difference between both group.(2) Compared with DNTH group, the A peak were higher and E/A was lower in DSDH group,(93.18±25.37)cm/s vs.(86.85±25.26)cm/s, 0.82±0.34 vs. 0.94±0.40, all P<0.05.(3) Compared with normal diastolic function group, the HCY, FIB and TSH level were higher in the diastolic dysfunction group,(18.42±9.25)mmol/L vs.(15.06±7.07)mmol/L,(3.11±0.91)g/L vs.(2.78±0.71)g/L,(3.43±3.34)m U/L vs.(2.57±1.88)m U/L, all P<0.05.(4) In multivariable linear models, disease course, DBP, LDL, HCY and TSH were included in regression equation of man(Beta=-0.732,-0.520,-0.325,-0.395,-0.582, P<0.05). While disease course, SBP, Hb A1 c, TSH were included in regression equation of woman(Beta=-0.438,-0.807,-0.462,-0.415, P<0.05). Conclusion Subclinical hypothyroidism may lead to diastolic dysfunction in T2 DM patients, which was influenced by the increased FIB level.更多还原