Zhong Luojing, Lin Ruiyu, Cao Baozhen, Zhong Wenying, Tu Mei, Wei Wen
Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
Department of Physical Examination, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
Front Endocrinol (Lausanne). 2025 Jun 25;16:1591108. doi: 10.3389/fendo.2025.1591108. eCollection 2025.
The relationship between thyroid hormone sensitivity and lipoprotein(a) (Lp(a)) is unclear. The purpose of this study is to illuminate the correlation between thyroid hormone sensitivity and Lp(a) in euthyroid patients with type 2 diabetes mellitus (T2DM).
A cross-sectional study was conducted on 1097 patients with T2DM. The 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. Linear and binary logistic regression analysis were performed to assess the relationship between thyroid hormone sensitivity indices and Lp(a). Restricted cubic splines were also used to evaluate the association between thyroid hormone sensitivity indices and Lp(a).
Among the 1097 participants, the percentage of Lp(a)≥30 mg/dL was 20.3%. Linear regression analysis revealed that TFQI displayed a positive correlation with Lp(a) levels, whereas the FT3/FT4 ratio exhibited a negative correlation. The adjusted odds ratio (aOR)(95% confidence interval(CI)) for high Lp(a) level was increased with rising TFQI quartiles(Q3: aOR 1.49,95% CI 1.09-2.06; Q4: aOR 1.74, 95% CI 1.36-2.23) (<0.05),with Q1 as the reference. By contrast,the aOR(95% CI) for high Lp(a) level was decreased with rising FT3/FT4 ratio quartiles (<0.05). The robustness of these findings was further confirmed by restricted cubic spline analysis.
In euthyroid T2DM patients, decreased sensitivity to thyroid hormones was found to be linked with high Lp(a) level. Screening for thyroid hormone insensitivity and serum Lp(a) levels should be emphasized in euthyroid T2DM patients for early intervention and improved outcomes.
甲状腺激素敏感性与脂蛋白(a) [Lp(a)] 之间的关系尚不清楚。本研究旨在阐明甲状腺功能正常的2型糖尿病（T2DM）患者中甲状腺激素敏感性与Lp(a)之间的相关性。
对1097例T2DM患者进行了一项横断面研究。计算甲状腺激素敏感性指标、基于甲状腺反馈分位数的指标（TFQI）、促甲状腺激素指标（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。进行线性和二元逻辑回归分析以评估甲状腺激素敏感性指标与Lp(a)之间的关系。还使用受限立方样条来评估甲状腺激素敏感性指标与Lp(a)之间的关联。
在1097名参与者中，Lp(a)≥30 mg/dL的比例为20.3%。线性回归分析显示，TFQI与Lp(a)水平呈正相关，而FT3/FT4比值呈负相关。以Q1为参照，随着TFQI四分位数升高，高Lp(a)水平的调整优势比（aOR）（95%置信区间[CI]）增加（Q3：aOR 1.49，95% CI 1.09 - 2.06；Q4：aOR 1.74，95% CI 1.36 - 2.23）（P<0.05）。相比之下，随着FT3/FT4比值四分位数升高，高Lp(a)水平的aOR（95% CI）降低（P<0.05）。受限立方样条分析进一步证实了这些发现的稳健性。
在甲状腺功能正常的T2DM患者中，发现对甲状腺激素的敏感性降低与高Lp(a)水平有关。对于甲状腺功能正常的T2DM患者，应强调筛查甲状腺激素不敏感性和血清Lp(a)水平，以便早期干预并改善预后。
