| Objective: To explore the changes of serum free triiodothyronine(FT3),serum free thyroxine(FT4),thyroid stimulating hormone(TSH)and leptin(LEP)in patients with type 2 diabetes(T2DM)comorbid depression,and deeply analyze the effect of TSH and LEP changes on bone mineral density(BMD)in patients with T2 DM comorbid depression.Methods: A total of patients with T2 DM comorbid depression who underwent BMD testing in the Physical Examination Center of Linshu People’s Hospital from December2018 to June 2021 were collected,and the general demographic data,laboratory biochemical and glycosylated hemoglobin indexes,thyroid hormones and BMD index was measured by Dual-energy X-ray absorptiometry was used to measure the lumbar BMD of the patients.According to the test results,the subjects were divided into an observation group(subjects with reduced lumbar vertebral bone density)and a control group(subjects with normal lumbar vertebral bone density).Propensity score matching(PSM)was used to match the demographic data and biochemical indicators such as blood glucose,glycosylated hemoglobin,blood lipids,etc.of the observation group and the control group 1: 1(caliper value = 0.01).Pearson correlation analysis was used to analyze the BMD of the lumbar spine and femoral neck.The relationship between thyroid hormone and LEP,multivariate logistic regression analysis was used to analyze the possible effects of thyroid hormone and LEP on lumbar spine BMD in T2 DM comorbid depression,and further ROC curve analysis was performed to evaluate thyroid hormone and LEP.The diagnostic and predictive value of LEP and combined TCM syndrome scores in the reduction of lumbar spine BMD in patients with T2 DM comorbid depression.Results: A total of 350 patients eligible for inclusion and exclusion were included in the study,including 141 patients in the observation group,209 in the control group,and TSH(t=16.20,P<0.001)and LEP(t=2.67,P<0.001)in both the observation group and the control group.0.001),there were significant differences.After propensity score matching,a total of 117 pairs of subjects were successfully matched,and there were still significant differences in the levels of TSH and LEP between the observation group and the control group(P<0.05).There was a linear correlation between TSH level and lumbar spine BMD(r=0.43,P<0.001)(r=0.24,P<0.001).The results of multivariate logistic regression analysis showed that TSH and LEP were associated with lumbar spine in patients with T2 DM comorbid depression.The related factors of BMD decrease(OR=0.051,95%CI=0.022-0.117)、(OR=1.535,95%CI=1.168-2.016).The ROC curve showed that the AUC of TSH for the prediction of lumbar vertebral BMD was 0.91,and the TSH level of 2.16 u IU/m L was the best cut-off value for the diagnosis of BMD loss,with a sensitivity of 92.3% and a specificity of 82.1%.The AUC of LEP for the prediction of lumbar BMD was 0.72,and the TSH level of 2.81ug/m L was the best cut-off value for the diagnosis of BMD loss,with a sensitivity of 84.6% and a specificity of 47.0%.The predictive value of TSH combined with LEP for lumbar spine BMD was significantly better than that of LEP alone(P<0.001,95%CI=0.135-0.256).The predictive value of TSH,LEP combined with TCM symptom score was significantly better than the predictive value of TSH combined with LEP on hip BMD(P=0.045,95%CI=0.001-0.058)and TSH(P=0.039,95%CI =0.002～0.067)and LEP(P<0.001,95%CI=0.163～0.286)alone predictive value.Neither FT3 nor FT4 showed a correlation with lumbar spine BMD in each analysis.Conclusion: 1.No correlation was found between FT3,FT4 and T2 DM comorbid depression patients with lumbar spine BMD;2.After PSM,TSH and LEP still have high predictive value for predicting the reduction of lumbar spine BMD in patients with T2 DM comorbid depression;3.TSH combined with LEP and TCM syndrome score can improve the sensitivity and uniqueness of prediction,which provides data support for the diagnosis of diseases by integrated TCM and Western medicine. |
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