HbA1c、E2、C肽对围绝经期、绝经后2型糖尿病患者合并亚临床甲状腺功能减退症的诊断价值

Diagnostic value of HbA1c, E2, and C-peptide levels for subclinical hypothyroidism in perimenopausal and postmenopausal women with T2DM

摘要:

目的 探讨糖化血红蛋白（HbA1c）、雌二醇（E₂）、餐后2 h C肽与围绝经期、绝经后2型糖尿病（T2DM）患者合并亚临床甲状腺功能减退症的关系。方法 选取2020年5月—2021年10月三亚市人民医院妇产科收治的围绝经期及绝经后T2DM患者254例为研究对象，其中，围绝经期146例，绝经后108例。围绝经期T2DM患者合并亚临床甲状腺功能减退症为观察一组、未合并的为对照一组；绝经后T2DM患者合并亚临床甲状腺功能减退症为观察二组、未合并的为对照二组。比较各组患者的临床资料；多因素Logistic回归分析亚临床甲状腺功能减退症发生的影响因素。绘制受试者工作特征（ROC）曲线，以曲线下面积（AUC）评价HbA1c、E₂、餐后2 h C肽及三者联合对围绝经期、绝经后T2DM患者合并亚临床甲状腺功能减退症的诊断价值。结果 围绝经期、绝经后T2DM患者亚临床甲状腺功能减退症发生率比较，差异无统计学意义（P >0.05）。观察一组和观察二组的T2DM病程、血尿酸、尿白蛋白、卵泡雌激素（FSH）、黄体生成素（LH）、HbA1c及餐后2 h C肽高于对照一组和对照二组（P <0.05），E₂低于对照一组和对照二组（P <0.05）。多因素Logistic回归分析显示：T2DM病程［O^R=2.793（95% CI：1.032，3.058）］、尿白蛋白［O^R=2.869（95% CI：1.574，4.086）］、HbA1c［（O^R=3.152（95% CI：2.036，5.183）］、E₂［O^R=3.340（95% CI：2.415，5.436）］、餐后2 h C肽［O^R=3.504（95% CI：2.874，6.879）］是影响围绝经期T2DM患者合并亚临床甲状腺功能减退症的危险因素（P <0.05）；T2DM病程［O^R=2.846（95% CI：1.029，3.186）］、HbA1c［O^R=3.074（95% CI：1.873，4.159）］、E₂［O^R=3.235（95% CI：2.057，5.836）］、餐后2 h C肽［O^R=3.691（95% CI：2.726，7.469）］是影响绝经后T2DM患者合并亚临床甲状腺功能减退症的危险因素（P <0.05）。ROC曲线分析结果显示，HbA1c、E₂、餐后2 h C肽及三者联合诊断围绝经期T2DM患者合并亚临床甲状腺功能减退症的敏感性分别为71.79%（95% CI：0.549，0.845）、66.67%（95% CI：0.497，0.804）、74.36%（95% CI：0.576，0.864）、66.67%（95% CI：0.497，0.804），特异性分别为76.64%（95% CI：0.673，0.840）、78.50%（95% CI：0.693，0.856）、67.29%（95% CI：0.575，0.759）、98.13%（95% CI：0.928，0.997），AUC分别为0.751（95% CI：0.673，0.819）、0.772（95%CI：0.693，0.837）、0.686（95% CI：0.604，0.760）、0.894（95% CI：0.852，0.951）。ROC曲线结果显示，HbA1c、E₂、餐后2 h C肽及三者联合诊断绝经后T2DM合并亚临床甲状腺功能减退症的敏感性分别为75.00%（95% CI：0.575，0.873）、69.44%（95%CI：0.517，0.831）、72.22%（95% CI：0.546，0.852）、69.44%（95% CI：0.517，0.831），特异性分别为66.67%（95% CI：0.545，0.873）、77.78%（95% CI：0.662，0.864）、75.00%（95% CI：0.632，0.841）、95.83%（95% CI：0.875，0.989），AUC分别为0.711（95% CI：0.616，0.794）、0.747（95% CI：0.655，0.826）、0.681（95% CI：0.584，0.767）、0.915（95% CI：0.845，0.960）。结论 HbA1c、E₂、餐后2 h C肽是围绝经期、绝经后T2DM患者合并亚临床甲状腺功能减退症的危险因素，且三者联合对围绝经期及绝经后T2DM患者亚临床甲状腺功能减退症的诊断效能较高。

Abstract:

Objective To investigate the relationship of the levels of glycosylated hemoglobin (HbA1c), estradiol (E₂) and 2 h postprandial C-peptide with subclinical hypothyroidism in perimenopausal and postmenopausal women with type 2 diabetes mellitus (T2DM).Methods A total of 254 perimenopausal and postmenopausal T2DM female patients admitted to our hospital from May 2020 to October 2021 were selected as the research objects, 146 cases were perimenopausal and 108 cases were postmenopausal. Perimenopausal female patients with T2DM with subclinical hypothyroidism were treated as observation group Ⅰ, and those without hypothyroidism were treated as control group Ⅰ; Patients with subclinical hypothyroidism in postmenopausal women with T2DM were included in the observation group Ⅱ, and those without clinical hypothyroidism were included in the control group Ⅱ. The clinical data of perimenopausal and postmenopausal female patients with T2DM with and without subclinical hypothyroidism were compared. The factors affecting the occurrence of subclinical hypothyroidism were analyzed with logistic multivariate regression. The receiver operating characteristic curve (ROC) was prepared, and the area under the curve (AUC) was used to evaluate the diagnostic value of HbA1c, E₂, 2 h postprandial C-peptide, and their combination in perimenopausal and postmenopausal women with T2DM for the diagnosis of subclinical hypothyroidism.Results There was no significant difference in the incidence of subclinical hypothyroidism between perimenopausal and postmenopausal women with T2DM (P > 0.05). The course of T2DM, serum uric acid, urine albumin, follicular estrogen (FSH), luteinizing hormone (LH), HbA1c, and C-peptide 2 h postprandial in the observation group Ⅰ and observation group Ⅱ were higher than those in the control group Ⅰ and control group Ⅱ (P < 0.05), while E2 was lower than that in the control group Ⅰ and control group Ⅱ (P < 0.05). Logistic multivariate analysis showed that the course of T2DM, urinary albumin, HbA1c, E₂, and C-peptide levels at 2 h postprandial were the risk factors for the occurrence of subclinical hypothyroidism in perimenopausal women with T2DM (P < 0.05). Duration of T2DM [O^R = 2.793 (95% CI: 1.032, 3.058) ], urinary albumin [O^R = 2.869 (95% CI: 1.574, 4.086) ], HbA1c [O^R = 3.152 (95% CI: 2.036, 5.183) ], E₂ [O^R = 3.340 (95% CI: 2.415, 5.436) ], and 2 h postprandial C-peptide [O^R = 3.504 (95% CI: 2.874, 6.879) ] were risk factors for subclinical hypothyroidism in perimenopausal female patients with T2DM (P < 0.05); Course of T2DM [O^R = 2.846 (95% CI: 1.029, 3.186) ], HbA1c[O^R = 3.074 (95% CI: 1.873, 4.159) ], E₂ [O^R = 3.235 (95% CI: 2.057, 5.836) ], and 2 h postprandial C-peptide [O^R = 3.691 (95% CI: 2.726, 7.469) ] were risk factors for subclinical hypothyroidism in postmenopausal women with T2DM (P < 0.05). The results of ROC curve analysis showed that the sensitivity of HbA1c, E₂, 2 h postprandial C-peptide, and their combination in the diagnosis of subclinical hypothyroidism in perimenopausal T2DM women were 71.79% (95% CI: 0.549, 0.845), 66.67% (95% CI: 0.497, 0.804), 74.36% (95% CI: 0.576, 0.864), and 66.67% (95% CI: 0.497, 0.804), respectively; the specificity was 76.64% (95% CI: 0.673, 0.840), 78.50% (95% CI: 0.693, 0.856), 67.29% (95% CI: 0.575, 0.759), and 98.13% (95% CI: 0.928, 0.997) , respectively; AUC were 0.751 (95% CI: 0.673, 0.819), 0.772 (95% CI: 0.693, 0.837), 0.686 (95% CI: 0.604, 0.760), and 0.894 (95% CI: 0.852, 0.951), respectively. The results of ROC curve analysis showed that the sensitivity of HbA1c, E₂, 2 h postprandial C-peptide, and their combination in the diagnosis of SCH in postmenopausal women with T2DM was 75.00% (95% CI: 0.575, 0.873), 69.44% (95% CI: 0.517, 0.831), 72.22% (95% CI: 0.546, 0.852), and 69.44% (95% CI: 0.517, 0.831), respectively; the specificity was 66.67% (95% CI: 0.545, 0.873), 77.78% (95% CI: 0.662, 0.864), 75.00% (95% CI: 0.632, 0.841), and 95.83% (95% CI: 0.875, 0.989) , respectively; AUCs were 0.711 (95% CI: 0.616, 0.794), 0.747 (95% CI: 0.65, 0.826), 0.681 (95% CI: 0.584, 0.767), and 0.915 (95% CI: 0.845, 0.960), respectively.Conclusion The levels of HbA1c, E₂, and C-peptide at 2 h postprandial are related to perimenopausal and postmenopausal women with T2DM complicated with subclinical hypothyroidism, and the combination of the three has a higher efficacy in diagnosing subclinical hypothyroidism in perimenopausal and postmenopausal women with T2DM.