Department of Vascular Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.
Acta Diabetol. 2019 Apr;56(4):431-440. doi: 10.1007/s00592-018-1231-y. Epub 2018 Sep 27.
To evaluate the relationship between thyroid-stimulating hormone (TSH) levels within the normal range and the risk of type 2 diabetes mellitus (T2DM) in a cohort of patients at high cardiovascular risk, and to perform a systematic review and meta-analysis of previous studies.
We included 5542 patients without T2DM from the prospective Secondary Manifestations of ARTerial disease study with TSH levels between 0.35 and 5.0 mIU/L without anti-thyroid medication or thyroid-hormone replacement therapy. Cox regression was used to investigate the relationship between baseline plasma TSH levels and incident T2DM. MEDLINE, EMBASE, and Cochrane were searched for prospective cohorts assessing TSH and incident T2DM. Hazard ratios (HR) from included prospective cohort studies were pooled using a random-effects model.
In patients at high cardiovascular risk, higher plasma TSH levels in the normal range were not associated [HR 1.07 per mIU/L increase in TSH (95% confidence interval (95% CI) 0.95-1.22)] with an increased risk of T2DM, adjusted for age, sex, smoking, total and HDL cholesterol, and triglycerides. In the meta-analysis involving three prospective cohort studies, including the present study, including 29,791 participants with 1930 incident events, there was no relation between plasma TSH levels in the normal range and incident T2DM [pooled HR 1.06 (95% CI 0.99-1.14)].
There is no apparent relation between plasma TSH levels in the normal range and incident T2DM in patients at high cardiovascular risk.
评估心血管高危患者中甲状腺刺激激素（TSH）水平处于正常范围内与 2 型糖尿病（T2DM）风险之间的关系，并对先前的研究进行系统评价和荟萃分析。
我们纳入了前瞻性动脉疾病二次表现研究中的 5542 例无 T2DM 的患者，这些患者的 TSH 水平在 0.35 至 5.0 mIU/L 之间，且无抗甲状腺药物或甲状腺激素替代治疗。采用 Cox 回归分析探讨基线血浆 TSH 水平与新发 T2DM 之间的关系。检索 MEDLINE、EMBASE 和 Cochrane 以评估 TSH 和新发 T2DM 的前瞻性队列研究。使用随机效应模型对纳入的前瞻性队列研究的危险比（HR）进行汇总。
在心血管高危患者中，正常范围内较高的血浆 TSH 水平与 T2DM 风险增加无关[TSH 每增加 1 mIU/L，HR 为 1.07（95%置信区间（95%CI）为 0.95-1.22）]，校正年龄、性别、吸烟、总胆固醇和高密度脂蛋白胆固醇及甘油三酯后仍如此。在涉及包括本研究在内的三项前瞻性队列研究的荟萃分析中，共纳入 29791 例参与者和 1930 例新发事件，正常范围内的血浆 TSH 水平与新发 T2DM 之间无相关性[汇总 HR 为 1.06（95%CI 为 0.99-1.14）]。
在心血管高危患者中，正常范围内的血浆 TSH 水平与新发 T2DM 之间似乎没有关系。
