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IF 1 Q3 MEDICINE, GENERAL & INTERNAL

Cureus Pub Date : 2025-02-17 eCollection Date: 2025-02-01 DOI:10.7759/cureus.79186

N M Motachim Mahmud, Dhierin R Jagdewsing, Xiaochen Ji, Ibrahim Harine, Bahassane Adjibou, Noor Safra C Fahmy, Thomas Juby, Rafiul I Shuvo, Ausraful Alam, Saudeya Sarmin

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摘要

目的：亚临床甲状腺功能减退症（SCH）经常见于2型糖尿病（T2DM）患者，由于其对代谢和甲状腺功能参数的影响，可能会加重大血管并发症。本研究旨在探讨不同水平的促甲状腺激素（TSH）与大血管并发症风险之间的关系，同时分析T2DM SCH患者的主要代谢、人口统计学和临床因素：大连医科大学附属第二医院开展了一项回顾性研究，收集了2017年至2023年的数据。根据TSH水平将305例患者分为三组，分别为T2DM轻度SCH（TSH 4.34-6.9 mIU/L）、T2DM中度SCH（TSH 7.0-9.9 mIU/L）和T2DM重度SCH（TSH水平10.0 mIU/L以上）。分类变量采用卡方检验，连续变量采用单因素方差分析（ANOVA）。为确定大血管并发症的风险，进行了单变量和多变量二元逻辑回归分析。此外，统计显著性以 p 为标准：重度 SCH 患者的大血管并发症发生率最高，为 19 例（90.5%），其次是中度 SCH 38 例（80.9%）和轻度 SCH 142 例（59.9%）（p < 0.001）。多变量分析显示，与轻度SCH相比，中度SCH患者出现大血管并发症的风险增加了4.35倍（OR：4.352，95% CI：1.761-10.754，p = 0.001），重度SCH患者出现大血管并发症的风险增加了6.08倍（OR：6.075，95% CI：1.202-30.715，p = 0.029）。65岁及以上年龄组、男性和重度SCH是大血管并发症的重要预测因素。外周动脉疾病（PAD）和冠状动脉疾病（CAD）与重度SCH尤其相关（OR：5.913，p < 0.001；OR：3.268，p = 0.013）：结论：患有重度或中度SCH的T2DM患者发生大血管并发症的风险明显更高，尤其是PAD和CAD。及时干预和密切监测促甲状腺激素水平，尤其是老年患者和男性患者的促甲状腺激素水平，对于降低这些风险至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Association Between Different Thyroid-Stimulating Hormone Levels and Macrovascular Complications in Subclinical Hypothyroidism Patients With Type 2 Diabetes Mellitus.

Aim: Subclinical hypothyroidism (SCH) is frequently observed in patients with type 2 diabetes mellitus (T2DM) and may exacerbate macrovascular complications due to its impact on metabolic and thyroid function parameters. This study aims to explore the association between varying levels of thyroid-stimulating hormone (TSH) and the risk of macrovascular complications, alongside analyzing key metabolic, demographic, and clinical factors in T2DM patients with SCH.

Methods: A retrospective study was conducted at the Second Affiliated Hospital of Dalian Medical University, and data was collected from 2017 to 2023. According to their TSH levels, 305 patients were divided into three groups, which were T2DM mild SCH (TSH 4.34-6.9 mIU/L), T2DM moderate SCH (TSH 7.0-9.9 mIU/L), and T2DM severe SCH (TSH levels of 10.0 mIU/L or higher). The chi-square test was used for categorical variables, while one-way analysis of variance (ANOVA) was used for continuous variables. Univariate and multivariate binary logistic regression analysis was performed to determine the risk of macrovascular complications. Further, a statistical significance was set at p <0.05.

Results: Patients with severe SCH had the highest incidence of macrovascular complications, 19 (90.5%), followed by moderate SCH 38 (80.9%) and mild SCH 142 (59.9%) (p < 0.001). Multivariate analysis revealed a 4.35-fold increased risk (OR: 4.352, 95% CI: 1.761-10.754, p = 0.001) for macrovascular complications in moderate SCH and a 6.08-fold increased risk (OR: 6.075, 95% CI: 1.202-30.715, p = 0.029) in severe SCH compared to mild SCH. Age group 65 and older, male sex, and severe SCH were significant predictors of macrovascular complications. Peripheral artery disease (PAD) and coronary artery disease (CAD) were particularly associated with severe SCH (OR: 5.913, p < 0.001; OR: 3.268, p = 0.013, respectively).

Conclusion: T2DM patients with severe or moderate SCH are at significantly higher risk of macrovascular complications, especially PAD and CAD. Timely intervention and close monitoring of TSH levels, particularly in older and male patients, are essential to mitigate these risks.

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Cureus

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