2 型糖尿病患者甲状腺功能障碍与心血管发病率和死亡率的关系：弗里曼特尔糖尿病研究第二阶段。
The relationship between thyroid dysfunction, cardiovascular morbidity and mortality in type 2 diabetes: The Fremantle Diabetes Study Phase II.
机构信息
Medical School, Faculty of Health and Medical Sciences, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia.
PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital, Murdoch, WA, Australia.
出版信息
Acta Diabetol. 2022 Dec;59(12):1615-1624. doi: 10.1007/s00592-022-01969-x. Epub 2022 Sep 9.
AIMS
It is uncertain whether subclinical thyroid dysfunction is associated with cardiovascular disease (CVD) events and mortality in people with type 2 diabetes. The aim of this study was to determine whether undetected thyroid disease increases the risk of incident CVD and death in type 2 diabetes.
METHODS
One thousand two hundred fifty participants with type 2 diabetes (mean age 65.3 years, 56.5% males, median diabetes duration 8.0 years) without known thyroid disease and not taking medications known to affect thyroid function were categorised, based on baseline serum free thyroxine (FT4) and thyrotropin (TSH) concentrations, as euthyroid, overt hypothyroid (increased TSH, low FT4), subclinical hypothyroid (increased TSH, normal FT4), overt thyrotoxic (decreased TSH, raised FT4) or subclinical thyrotoxic (decreased TSH, normal FT4). Incident myocardial infarction, incident stroke, all-cause and cardiovascular mortality were ascertained during a mean 6.2-6.7 years of follow-up.
RESULTS
Most participants with newly-detected thyroid dysfunction had subclinical hypothyroidism (77.2%) while overt/subclinical thyrotoxicosis was infrequent. Compared to participants with TSH 0.34-2.9 mU/L, those with TSH > 5.1 mU/L were not at increased risk of incident myocardial infarction (adjusted hazard ratio (95% confidence limits) 1.77 (0.71, 2.87)), incident stroke (1.66 (0.58, 4.78)), all-cause mortality (0.78 (0.44, 1.37)) or cardiovascular mortality (1.16 (0.38, 3.58)). Independent baseline associates of subclinical hypothyroidism included estimated glomerular filtration rate and systolic blood pressure.
CONCLUSIONS
Subclinical hypothyroidism was not independently associated with CVD events or mortality in community-dwelling people with type 2 diabetes despite its associations with CVD risk factors, questioning strategies to identify and/or treat mild thyroid dysfunction outside usual care.
目的
亚临床甲状腺功能障碍是否与 2 型糖尿病患者的心血管疾病（CVD）事件和死亡率相关尚不确定。本研究旨在确定未检出的甲状腺疾病是否会增加 2 型糖尿病患者 CVD 事件和死亡的风险。
方法
1250 名患有 2 型糖尿病（平均年龄 65.3 岁，56.5%为男性，中位糖尿病病程 8.0 年）、无已知甲状腺疾病且未服用已知影响甲状腺功能药物的患者，根据基线游离甲状腺素（FT4）和促甲状腺激素（TSH）浓度进行分类，分为甲状腺功能正常、显性甲状腺功能减退（TSH 升高，FT4 降低）、亚临床甲状腺功能减退（TSH 升高，FT4 正常）、显性甲状腺毒症（TSH 降低，FT4 升高）或亚临床甲状腺毒症（TSH 降低，FT4 正常）。在平均 6.2-6.7 年的随访期间，确定了新发甲状腺功能障碍患者的心肌梗死、卒中等 CVD 事件以及全因和心血管死亡率。
结果
新发现的甲状腺功能障碍患者中大多数为亚临床甲状腺功能减退症（77.2%），而显性/亚临床甲状腺毒症较为少见。与 TSH 0.34-2.9 mU/L 的患者相比，TSH>5.1 mU/L 的患者新发心肌梗死（调整后的危险比（95%置信区间）1.77（0.71，2.87））、新发卒中等 CVD 事件（1.66（0.58，4.78））、全因死亡率（0.78（0.44，1.37））或心血管死亡率（1.16（0.38，3.58））的风险无显著增加。亚临床甲状腺功能减退症的独立基线相关因素包括估计肾小球滤过率和收缩压。
结论
尽管亚临床甲状腺功能减退症与 CVD 危险因素相关，但在社区居住的 2 型糖尿病患者中，其与 CVD 事件或死亡率无独立相关性，这对常规治疗以外识别和/或治疗轻度甲状腺功能障碍的策略提出了质疑。
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