Department of Diabetology and Internal Diseases, Medical University of Warsaw, Warsaw, Polska.
Department of Internal Diseases, Endocrinology, and Diabetology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Polska.
Endokrynol Pol. 2022;73(2):301-308. doi: 10.5603/EP.a2022.0018. Epub 2022 Apr 5.
It has been hypothesized that autoimmunity may contribute to cardiovascular complications and may be an important trigger for processes leading to atherosclerosis, especially in type 1 diabetes mellitus (T1DM). This pilot study aimed to answer the question of whether markers of thyroid autoimmunity are associated with increased carotid intima-media thickness (cIMT) in young, asymptomatic T1DM women.
The study population consisted of 102 women, including 72 with T1DM and 30 healthy controls. All patients had thyroid hormones within the normal range. According to the antiperoxidase antibodies (aTPO) titre, the T1DM women were divided into an aTPO-positive (T1DM aTPO+) (n = 41) and an aTPO-negative (T1DM aTPO-) (n = 31) group. In all patients, aTPO, thyroglobulin antibody (aTG) titres, thyroid-stimulating hormone (TSH), free thyroxine (FT3), free triiodothyronine (FT4), lipid parameters, glycated haemoglobin, thyroid ultrasonography, and cIMT assessment were evaluated. The association of cIMT with different risk factors related to thyroid autoimmunity was determined.
Carotid intima-media thickness was significantly greater in T1DM aTPO+ females (0.66 ± 0.10 mm) than in T1DM aTPO- (0.59 ± 0.11 mm) and healthy controls (0.58 ± 0.10 mm) (p = 0.007, p = 0.001, respectively). In all women cIMT was significantly, positively correlated with aTPO (p = 0.005, r = 0.273), Hashimoto's thyroiditis (HT) duration (p = 0.00015, r = 0.367), levothyroxine dose per week (p = 0.006, r = 0.269), and ultrasound features of HT (p = 0.004, r = 0.281) and inversely with fT3 concentration (p = 0.014, r = -0.243) and FT3/FT4 ratio (p = 0.042, r = -0.201). A logistic regression analysis showed that HT duration (OR: 1.102, 95% CI: 1.008-1.206, p = 0.032) and a positive history family of HT (OR: 3.909, 95%CI: 1.014-15.071, p = 0.045) were risk factors for increased cIMT. However, multivariate regression analysis showed that the studied parameters related to thyroid autoimmunity are not independent risk factors for increased cIMT.
We expanded the data on cIMT in young women with T1DM and showed that thyroid autoimmunity, and in particular the duration of exposure to anti-thyroid antibodies, despite adequate levothyroxine substitution, is associated with subclinical atherosclerosis in young women with T1DM. However, thyroid-related parameters are not independent risk factors for increased cIMT in euthyroid women.
据推测，自身免疫可能与心血管并发症有关，并且可能是导致动脉粥样硬化发生的重要触发因素，尤其是在 1 型糖尿病（T1DM）中。本研究旨在回答甲状腺自身抗体标志物是否与年轻无症状 T1DM 女性的颈动脉内膜中层厚度（cIMT）增加有关。
研究人群包括 102 名女性，其中 72 名患有 T1DM，30 名健康对照者。所有患者的甲状腺激素均在正常范围内。根据抗过氧化物酶抗体（aTPO）滴度，将 T1DM 女性分为 aTPO 阳性（T1DM aTPO+）（n = 41）和 aTPO 阴性（T1DM aTPO-）（n = 31）组。所有患者均评估 aTPO、甲状腺球蛋白抗体（aTG）滴度、促甲状腺激素（TSH）、游离甲状腺素（FT3）、游离三碘甲状腺原氨酸（FT4）、血脂参数、糖化血红蛋白、甲状腺超声和 cIMT 评估。确定 cIMT 与与甲状腺自身免疫相关的不同危险因素之间的关系。
T1DM aTPO+女性的 cIMT（0.66 ± 0.10 mm）明显大于 T1DM aTPO-（0.59 ± 0.11 mm）和健康对照组（0.58 ± 0.10 mm）（p = 0.007，p = 0.001）。在所有女性中，cIMT 与 aTPO 呈显著正相关（p = 0.005，r = 0.273），与桥本甲状腺炎（HT）持续时间（p = 0.00015，r = 0.367）、每周左旋甲状腺素剂量（p = 0.006，r = 0.269）和 HT 的超声特征（p = 0.004，r = 0.281）呈显著正相关，与 fT3 浓度（p = 0.014，r = -0.243）和 FT3/FT4 比值（p = 0.042，r = -0.201）呈显著负相关。逻辑回归分析显示，HT 持续时间（OR：1.102，95%CI：1.008-1.206，p = 0.032）和 HT 阳性家族史（OR：3.909，95%CI：1.014-15.071，p = 0.045）是 cIMT 增加的危险因素。然而，多元回归分析表明，与甲状腺自身免疫相关的研究参数不是 cIMT 增加的独立危险因素。
我们扩展了年轻 T1DM 女性 cIMT 的数据，并表明尽管接受了充分的左甲状腺素替代治疗，但甲状腺自身免疫，尤其是接触抗甲状腺抗体的持续时间，与年轻 T1DM 女性的亚临床动脉粥样硬化有关。然而，甲状腺相关参数不是甲状腺功能正常女性 cIMT 增加的独立危险因素。
