2型糖尿病合并不同水平高血压患者甲状腺激素水平变化及其相关性研究

Change of thyroid hormone in T2DM patients with different levels of hypertension and its potential correlation

摘要:

目的观察2型糖尿病（T2DM）合并不同水平高血压患者甲状腺激素水平的变化，并探讨其相关因素。方法选取T2DM合并高血压患者392 例，根据血压水平分为正常血压组135 例、高血压1 级组107 例、高血压2 级组89 例及高血压3 级组61 例。测定各组甲状腺激素水平，包括游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）及促甲状腺激素（TSH），并采用Pearson相关分析和多元逐步回归分析指标间的相关性。结果①随高血压水平升高，各组TSH 水平升高[0.42（0.22～0.88）vs 0.80（0.33～1.01）vs 1.45（0.97～2.11）vs 2.75（2.10～4.20）mIU/L]、FT3水平降低[（5.31±0.54）vs（4.79±0.66）vs（4.47±0.52）vs（3.51±0.30）pmol/L]（p <0.05），而各组间FT4水平比较，差异无统计学意义[（16.26±2.71）vs（16.04±2.75）vs（15.39±3.41）vs（16.30±2.70）pmol/L]（p >0.05）；②Pearson相关分析发现，FT3与高血压分级和年龄呈负相关（ r=-0.408 和-0.194，p =0.000 和0.042）；FT4 与TG 呈负相关，与HDL-C 呈正相关（r =-0.227 和0.189，p =0.028 和0.046），与高血压分级无相关性（ r=0.017，p=0.463）；TSH与高血压分级、BMI、TG、TC、LDL-C及SUA呈正相关（r =0.357、0.196、0.277、0.123、0.214 和0.342，p =0.005、0.041、0.025、0.046、0.020 和0.001），与HbA1c 呈负相关（r =-0.222，p =0.034）；③多元逐步回归分析发现，高血压分级和年龄为FT3 的影响因素（均p=0.00）；高血压分级和SUA 为TSH的影响因素（均p=0.00）；FT4未发现影响因素。结论随着血压水平的升高，TSH 水平升高、FT3 水平降低及FT4 水平无变化；高血压分级是FT3和TSH 的影响因素。

Abstract:

Objective To observe the change of thyroid hormone in T2DM patients with different levels of hypertension and discuss its potential relationship. Methods A total of 392 T2DM patients complicated with hypertension were divided into four groups: normal blood pressure group (n = 135), hypertension grade 1 group(n = 107), hypertension grade 2 group (n = 89) and hypertension grade 3 group (n = 61). Thyroid hormone including FT3, FT4 and TSH were tested among four groups, and the correlation was analyzed between thyroid hormone and blood pressure by Pearson correlation analysis and multiple step wise regression analysis. Results Along with the increase of hypertension grade, the levels of TSH was significantly elevated [0.42 (0.22-0.88)vs 0.80 (0.33 - 1.01) vs 1.45 (0.97-2.11) vs 2.75 (2.10-4.20) mIU/L,p < 0.05], the levels of FT3 was reduced[ (5.31 ±0.54) vs (4.79 ±0.66) vs (4.47 ±0.52) vs (3.51 ±0.30) pmol/L,p < 0.05]. No statistically significant differences in FT4 were observed among the four groups [ (16.26 ±2.71) vs (16.04 ±2.75) vs (15.39 ±3.41) vs(16.30 ±2.70) pmol/L,p > 0.05]. Pearson correlation analysis showed that FT3 was negatively correlated with hypertension grade and age (r = -0.408 and -0.194,p = 0.000 and 0.042, respectively); FT4 was negatively correlated with TG while positively correlated with HDL-C (r = -0.227 and 0.189,p = 0.028 and 0.046,respectively). No correlation of FT4 with hypertension grade was observed (r = 0.017, p= 0.463); TSH was positively correlated with hypertension grade, BMI, TG, TC, LDL-C and SUA (r = 0.357, 0.196, 0.277, 0.123,0.214 and 0.342;p = 0.005, 0.041, 0.025, 0.046, 0.020 and 0.001, respectively), while negatively correlated with HbA1c (r = -0.222,p = 0.034). Multiple linear regression analysis showed that hypertension grade and age were the influence factors of FT3; hypertension grade and SUA were the influence factors of TSH; no influence factor was found for FT4. Conclusions Along with the increase of hypertension grade, TSH increases, FT3 reduces and FT4 is stable. FT3 and TSH are the independent risk factors for hypertension grading.