Correlation Between Subclinical Hypothyroidism And Diabetic Macrovascular Complications In Patients With Type 2 Diabetes Mellitus

【Objective】To observe the changes of various indicators in patients with type2 diabetes mellitus in patients with subclinical hypothyroidism(SCH).To explore the correlation between subclinical hypothyroidism and diabetic macrovascular complications(DMD),and provide a theoretical basis for early clinical intervention of diabetes with methylene reduction.【Methods】A total of 6294 cases of T2 DM hospitalized in the Department of Endocrinology,the Third Affiliated Hospital of Anhui Medical University from January 2006 to December 2017 were collected.After scanning in the case room,Epi Data software was used for data entry,merged into a complete database,and selected data.Complete,in accordance with the inclusion criteria,and excluded the cases that met the exclusion criteria,and finally selected 2328 cases,and then divided them into three groups with TSH5.6u IU/ml and 10 u IU/ml as the cut-off points,of which the simple DM group(TSH≤5.6u IU)/ml)1810 cases;SCH1 group(5.6u IU/ml<TSH<10u IU/ml)308 cases,SCH2 group(TSH≥10u IU/ml)210 cases.Collect general patient information and auxiliary examinations: gender,age,course of disease,history of cardiovascular and cerebrovascular diseases,number of years of smoking,blood pressure,BMI(body mass index),etc.,8-10 hours after fasting,6-7 points in the morning,elbow venous blood test Fasting plasma glucose(FPG),glycosylated hemoglobin(Hb A1C),blood lipids(TG: triacylglycerol;TC: total cholesterol;LDL-C:low density cholesterol;HDL-C: high density cholesterol;),thyroid function and Related antibodies(TSH: thyrotropin;FT3: free trithyroxine;FT4: free thyroxine;TGAb: thyroglobulin antibody;TPOAb: thyroid peroxidase antibody;TRAb:thyrotropin receptor antibody),Electrocardiogram or 24-hour Holter,CT or MRI,color dual-function ultrasound.Age,duration of disease,number of years of smoking,BMI,systolic blood pressure,blood lipids,TSH,etc.were the independent variables,and the presence or absence of diabetic macrovascular complications as a dependent variable,the possible risk factors for the occurrence of diabetic macrovascular complications,compared between the three groups The characteristics of clinical data,especially pay attention to the risk factors associated with diabetic macrovascular complications after logistic regression analysis.If there are differences in risk factors for other major diabetic vascular complications in addition to thyroid function,further grouping is needed.It is possible to eliminate differences between groups.Finally,the incidence of diabetic macrovascular complications and carotid intima-media thickness(CIMT)were compared between the three groups.【Results】 1)Logistic regression analysis of risk factors for type 2 diabetic macroangiopathy:(1)TSH is a risk factor for diabetic macrovascular complications(P < 0.001,OR =2.588),suggesting that in patients with T2 DM,patients with SCH have a risk of developing diabetic macrovascular complications of 2.583 with normal thyroid function.Times.(2)Old age,long smoking years,high body mass index,high systolic blood pressure,high cholesterol,high triglyceride,high and low density lipoprotein,low high density lipoprotein,high thyroid stimulating hormone,high glycosylated hemoglobin,high blood sugar Risk factors for diabetic macrovascular complications(OR values were 1.023,1.025,1.032,1.202,1.010,0.710,5.367,0.370,0.296,2.588,1.090,1.131).2)Clinical characteristics of the study subjects:(1)Compared with the simple DM group,the incidence of TSH,female proportion,disease duration,glycosylated hemoglobin,systolic blood pressure,peripheral blood vessels of the neck and extremities increased,while FT3 and FT4 decreased,and the remaining indicators were not statistically different.(2)Compared with the simple DM group,the incidence of TSH,systolic blood pressure,female proportion,neck and neck and limb peripheral blood vessel lesions increased in the SCH1 group,while FT4 decreased,and the remaining indicators were not statistically different.(3)Compared with the simple DM group,the incidence of TSH,female proportion,neck and extremity vascular peripheral lesions increased,while FT3 and FT4 decreased,and the remaining indicators were not statistically different.(4)Compared with SCH1 group,the incidence of TSH,female proportion,glycosylated hemoglobin,neck and neck and extremity vascular peripheral lesions increased,while FT4 decreased,and the remaining indicators were not statistically different.3)Group again according to glycated hemoglobin:This experiment was grouped according to the high value of 7% of glycated hemoglobin control required by the Integrated Diabetes Control Standards in the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China in 2010.After Hb A1c≤7%,there was still a statistical difference in Hb A1 c between SCH1 group and SCH2 group(P<0.05),but the sample size of Hb A1c≤7% group was less.If further grouping again,the sample size will be Less than 20~30,the results will not be statistically significant,so this experiment is not further grouped,and there is still statistical difference in Hb A1 c between the two groups after this grouping,so this group is also meaningless.4)Comparison of the incidence of three groups of cardiovascular and cerebrovascular diseases:(1)Compared with the simple DM group,the incidence of coronary heart disease,cerebrovascular disease,and peripheral blood vessels of the limbs in the SCH1 group increased significantly(5.19% vs 2.21%,12.99% vs 8.12%,respectively).63.64% vs16.24%),the difference was statistically significant.(2)Compared with the simple DM group,the incidence of coronary heart disease,cerebrovascular disease,and peripheral blood vessels of the extremities in the SCH2 group increased significantly(40.00% vs 2.21%,41.43% vs 8.12%,respectively).82.86% vs 16.24%),the difference was statistically significant.(3)Compared with SCH1 group,the incidence of coronary heart disease,cerebrovascular disease,peripheral blood vessels of the neck and limbs increased significantly in SCH2 group(40.00% vs 5.19%,41.43% vs 12.99%,82.86,respectively).%vs63.64%),the difference was statistically significant.5)Comparison of three groups of carotid intima-media thickness:(1)Compared with the simple DM group,the carotid artery-medial thickness of the SCH1 group was significantly increased(1.14±0.57 vs 0.57±0.50,respectively),and the difference was statistically significant.(2)Compared with the simple DM group,the carotid artery intima-media thickness increased significantly in the SCH2 group(1.25±0.35 vs 0.57±0.50,respectively),and the difference was statistically significant.(3)Compared with the SCH1 group,the carotid intima-media thickness of the SCH2 group was significantly increased(1.25±0.35 vs 0.57±0.50,respectively),and the difference was statistically significant.【Conclusion】The incidence of macrovascular complications in patients with T2 DM with SCH is significantly increased.SCH is a risk factor for cardiovascular and cerebrovascular diseases in patients with T2 DM,and combined with high levels of TSH,the risk of cardiovascular and cerebrovascular diseases is higher,c IMT is more Thick,requiring early intervention.