甲状腺激素敏感性受损与 2 型糖尿病甲状腺功能正常患者的轻度认知障碍有关。
Impaired Sensitivity to Thyroid Hormones is Associated with Mild Cognitive Impairment in Euthyroid Patients with Type 2 Diabetes.
机构信息
Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China.
出版信息
Clin Interv Aging. 2023 Aug 3;18:1263-1274. doi: 10.2147/CIA.S413584. eCollection 2023.
PURPOSE
The prevalence of mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D) is rapidly increasing. Thyroid hormones are key regulators of cognitive function in adults. The purpose of this study was to investigate the relationship between thyroid hormone sensitivity and MCI in euthyroid T2D patients.
PATIENTS AND METHODS
A total of 400 euthyroid T2D patients were enrolled in this cross-sectional study, including 218 patients with normal cognition and 182 MCI patients. The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function. The free triiodothyronine to free thyroxine (FT3/FT4) ratio was calculated as a measure of peripheral sensitivity to thyroid hormones; the thyroid-stimulating hormone index (TSHI), thyrotrophic thyroxine resistance index (TT4RI) and thyroid feedback quantile-based index (TFQI) were calculated as measures of central sensitivity to thyroid hormones. Linear regression analysis and logistic regression analysis were performed to explore the relationships between these indices of thyroid hormone sensitivity and the MoCA score and MCI, respectively.
RESULTS
Compared with the normal cognitive function group, patients in the MCI group had higher TSHI, TT4RI and TFQI but a lower FT3/FT4 ratio (<0.05). The MoCA score was positively correlated with the FT3/FT4 ratio but negatively correlated with TSHI, TT4RI and TFQI (< 0.05). Multivariate logistic regression analysis showed that a low FT3/FT4 ratio and high TSHI, TT4RI and TFQI were independently associated with MCI (<0.05). After adjustment for confounding factors, the odds ratio (OR) for the association between MCI and the highest tertile of the FT3/FT4 was 0.455 (95% CI: 0.264-0.785), for the highest tertile of TSHI, the OR was 2.380 (95% CI: 1.376-4.119), for the highest tertile of TT4RI, the OR was 2.342 (95% CI:1.353-4.054), and for the highest tertile of TFQI, the OR was 2.536 (95% CI: 1.466-4.387) (< 0.05).
CONCLUSION
Impaired sensitivity to thyroid hormones is associated with MCI in euthyroid T2D patients.
目的
2 型糖尿病（T2D）患者轻度认知障碍（MCI）的患病率正在迅速上升。甲状腺激素是成人认知功能的关键调节剂。本研究旨在探讨甲状腺激素敏感性与甲状腺功能正常的 T2D 患者 MCI 之间的关系。
方法
本横断面研究共纳入 400 例甲状腺功能正常的 T2D 患者，其中正常认知患者 218 例，MCI 患者 182 例。采用蒙特利尔认知评估量表（MoCA）评估认知功能。计算游离三碘甲状腺原氨酸/游离甲状腺素（FT3/FT4）比值作为外周甲状腺激素敏感性的衡量指标；计算促甲状腺激素指数（TSHI）、甲状腺素抵抗促甲状腺激素指数（TT4RI）和甲状腺反馈定量指数（TFQI）作为甲状腺激素中枢敏感性的衡量指标。采用线性回归分析和 logistic 回归分析分别探讨这些甲状腺激素敏感性指标与 MoCA 评分和 MCI 之间的关系。
结果
与正常认知功能组相比，MCI 组患者的 TSHI、TT4RI 和 TFQI 更高，FT3/FT4 比值更低（<0.05）。MoCA 评分与 FT3/FT4 比值呈正相关，与 TSHI、TT4RI 和 TFQI 呈负相关（<0.05）。多变量 logistic 回归分析显示，FT3/FT4 比值低、TSHI、TT4RI 和 TFQI 高与 MCI 独立相关（<0.05）。调整混杂因素后，MoCA 与 FT3/FT4 比值最高三分位的比值比（OR）为 0.455（95%CI：0.264-0.785），与 TSHI 最高三分位的 OR 为 2.380（95%CI：1.376-4.119），与 TT4RI 最高三分位的 OR 为 2.342（95%CI：1.353-4.054），与 TFQI 最高三分位的 OR 为 2.536（95%CI：1.466-4.387）（<0.05）。
结论
甲状腺激素敏感性受损与甲状腺功能正常的 T2D 患者的 MCI 有关。
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