2型糖尿病患者甲状腺激素敏感性与非高密度脂蛋白胆固醇水平之间的关联
Association between sensitivity to thyroid hormones and non-high-density lipoprotein cholesterol levels in patients with type 2 diabetes mellitus.
作者信息
Duan Xiao-Ye, Fu Jun-Ling, Sun Li-Na, Mu Zhi-Jing, Xiu Shuang-Ling
机构信息
Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
出版信息
World J Diabetes. 2024 Oct 15;15(10):2081-2092. doi: 10.4239/wjd.v15.i10.2081.
BACKGROUND
Dyslipidemia and type 2 diabetes mellitus (T2DM) are chronic conditions with substantial public health implications. Effective management of lipid metabolism in patients with T2DM is critical. However, there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population, particularly concerning non-high-density lipoprotein cholesterol (non-HDL-C).
AIM
To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM.
METHODS
In this cross-sectional study, thyroid hormone sensitivity indices, the thyroid feedback quantile-based index (TFQI), the thyroid-stimulating hormone index (TSHI), the thyrotrophic T4 resistance index (TT4RI), and the free triiodothyronine (FT3)/free thyroxine (FT4) ratio were calculated. Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels. Random forest variable importance and Shapley Additive Explanations (SHAP) summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor.
RESULTS
Among the 994 participants, 389 (39.13%) had high non-HDL-C levels. Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI (OR: 1.584; 95%CI: 1.088-2.304; = 0.016), TSHI (OR: 1.238; 95%CI: 1.034-1.482; = 0.02), and TT4RI (OR: 1.075; 95%CI: 1.006-1.149; = 0.032) but was not significantly correlated with the FT3/FT4 ratio. The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex. An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men (OR: 1.331; 95%CI: 1.003-1.766; = 0.048) but elevated TFQI levels in women (OR: 2.337; 95%CI: 1.4-3.901; = 0.001). Among the analyzed variables, the average SHAP values were highest for TSHI, followed by TT4RI.
CONCLUSION
Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.
背景
血脂异常和2型糖尿病（T2DM）是具有重大公共卫生影响的慢性疾病。有效管理T2DM患者的脂质代谢至关重要。然而，T2DM人群中甲状腺激素敏感性与血脂异常之间的关系，尤其是关于非高密度脂蛋白胆固醇（非HDL-C），一直未得到充分关注。
目的
阐明T2DM患者甲状腺激素敏感性与血脂异常之间的关联。
方法
在这项横断面研究中，计算了甲状腺激素敏感性指标，即基于甲状腺反馈分位数的指数（TFQI）、促甲状腺激素指数（TSHI）、促甲状腺素T4抵抗指数（TT4RI）以及游离三碘甲状腺原氨酸（FT3）/游离甲状腺素（FT4）比值。进行逻辑回归分析以确定这些综合指标与非HDL-C水平之间的关联。使用随机森林变量重要性和Shapley加性解释（SHAP）汇总图来确定高非HDL-C与其主要预测因素之间关联的强度和方向。
结果
在994名参与者中，389名（39.13%）非HDL-C水平较高。逻辑回归分析显示，高非HDL-C的风险与TFQI（比值比：1.584；95%置信区间：1.088 - 2.304；P = 0.016）、TSHI（比值比：1.238；95%置信区间：1.034 - 1.482；P = 0.02）和TT4RI（比值比：1.075；95%置信区间：1.006 - 1.149；P = 0.032）呈正相关，但与FT3/FT4比值无显著相关性。甲状腺系统综合指标与非HDL-C水平之间的关系因性别而异。男性高非HDL-C风险增加与TSHI水平升高相关（比值比：1.331；95%置信区间：1.003 - 1.766；P = 0.048），而女性与TFQI水平升高相关（比值比：2.337；95%置信区间：1.4 - 3.901；P = 0.001）。在所分析的变量中，TSHI的平均SHAP值最高，其次是TT4RI。
结论
T2DM患者甲状腺激素敏感性受损与高非HDL-C水平相关。
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