Rodacki M, Zajdenverg L, Dantas J R, de Oliveira J E P, Luiz R R, Cobas R A, Palma C C S, Negrato C A, Gomes M B
Diabetes and Nutrition Section, Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Diabet Med. 2014 Dec;31(12):1665-72. doi: 10.1111/dme.12530. Epub 2014 Jul 25.
To investigate if thyroid-stimulating hormone (TSH) levels are associated with any differences in glycaemic control or diabetes-related complications in individuals with Type 1 diabetes.
This observational, cross-sectional and multicentre study included patients with Type 1 diabetes for ≥ 5 years, with a recent TSH measurement and without a known previous thyroid disease. Patients were divided into three groups according to TSH levels: 0.4-2.5 mU/l; 2.5-4.4 mU/l; and ≥ 4.5 mU/l.
We included 1205 individuals with a mean ± sd age of 23.8 ± 11.3 years. Seven patients had TSH levels <0.4 mU/l and were excluded from the comparison between groups. HbA1c levels, systolic and diastolic blood pressure, LDL cholesterol and disease duration were similar in all groups (P = 0.893, P = 0.548, P = 0.461, P = 0.575 and P = 0.764, respectively). The rates of diabetic retinopathy and GFR < 60/mL/min/1.73 m(2) differed between groups (P = 0.006 and P < 0.001, respectively) and were lower in those with lower TSH levels. Multivariate analysis confirmed these associations. The frequencies of retinopathy and GFR < 60 mL/min/1.73 m(2) were higher not only in patients with TSH ≥ 4.5 mU/l (odds ratio 1.878 and 2.271, respectively) but also in those with TSH levels of 2.5-4.4 mU/l (odds ratio 1.493 and 2.286, respectively), when compared with patients with TSH levels of 0.4-2.5 mU/l.
TSH levels of 0.4-2.5 mU/l are associated with a lower risk of diabetic retinopathy and renal failure in individuals with Type 1 diabetes, independently of glycaemic control and duration of the disease.
研究促甲状腺激素（TSH）水平是否与1型糖尿病患者血糖控制或糖尿病相关并发症的差异有关。
这项观察性、横断面多中心研究纳入了病程≥5年、近期测量过TSH且既往无已知甲状腺疾病的1型糖尿病患者。根据TSH水平将患者分为三组：0.4 - 2.5 mU/l；2.5 - 4.4 mU/l；≥4.5 mU/l。
我们纳入了1205名患者，平均年龄±标准差为23.8 ± 11.3岁。7名患者TSH水平<0.4 mU/l，被排除在组间比较之外。所有组的糖化血红蛋白水平、收缩压和舒张压、低密度脂蛋白胆固醇及病程相似（P分别为0.893、0.548、0.461、0.575和0.764）。糖尿病视网膜病变发生率和肾小球滤过率<60/mL/min/1.73 m²在组间存在差异（P分别为0.006和P<0.001），TSH水平较低者发生率较低。多变量分析证实了这些关联。与TSH水平为0.4 - 2.5 mU/l的患者相比，TSH≥4.5 mU/l的患者视网膜病变和肾小球滤过率<60 mL/min/1.73 m²的频率更高（优势比分别为1.878和2.271），TSH水平为2.5 - 4.4 mU/l的患者也是如此（优势比分别为1.493和2.286）。
对于1型糖尿病患者，0.4 - 2.5 mU/l的TSH水平与糖尿病视网膜病变和肾衰竭风险较低相关，且独立于血糖控制和病程。
