甲状腺功能正常的2型糖尿病患者甲状腺激素敏感性指数与冠心病的相关性-现代医学

甲状腺功能正常的2型糖尿病患者甲状腺激素敏感性指数与冠心病的相关性

单位：川北医学院附属医院内分泌科, 四川南充 637000

分类号：R587.1;R541.4

出版年·卷·期（页码）：2026·54·第三期（473-482）

摘要：

目的：评估甲状腺功能正常的2型糖尿病(T2DM)患者中，甲状腺激素敏感性指数与冠心病(CHD)风险之间的关联。方法：本研究采用回顾性设计，连续纳入2022年1月至2024年12月期间在我院接受冠状动脉造影的甲状腺功能正常T2DM患者454例。根据造影结果，将患者分为CHD组和非CHD组。采用多因素Logistic回归模型，分析外周敏感性指标和中枢敏感性指标与CHD风险的独立关联，并利用限制性立方样条模型检验显著关联指标的剂量-反应关系。进一步通过性别分层分析探讨关联的潜在异质性。所有模型均逐步校正了人口学特征、临床指标及代谢相关混杂因素。结果：在多因素校正模型中，较高的游离三碘甲状腺原氨酸/游离甲状腺素(FT3/FT4)值和参数化甲状腺反馈分位数指数(PTFQI)水平均与较低的CHD风险独立相关。与最低分位组相比，最高分位组FT3/FT4的比值比为0.29，PTFQI的比值比为0.07。限制性立方样条分析显示，这两种指数均与CHD风险呈线性负相关。性别分层分析表明，在男性患者中，FT3/FT4值和PTFQI均与CHD风险显著相关；而在女性患者中，仅较高的甲状腺激素抵抗指数(TT4RI)与风险增加相关。结论：在甲状腺功能正常的T2DM患者中，较高的外周和中枢甲状腺激素敏感性是CHD风险的保护因素，且存在剂量-反应关系。这种保护性关联具有明显的性别异质性，主要在男性患者中显著。

Objective: To assess the association between thyroid hormone sensitivity indices and coronary heart disease(CHD) risk in euthyroidtype 2 diabetes mellitus patients.Methods: In this retrospective study, we consecutively enrolled 454 euthyroid T2DM patients who underwent coronary angiography(CAG) between January 2022 and December 2024. Based on CAG results, patients were categorized into T2DM with CHD and T2DM alone groups. Multivariable Logistic regression models were employed to analyze the independent associations of peripheral and central thyroid hormone sensitivity indices with CHD risk. Restricted cubic spline(RCS) analyses were performed for significant indices to examine dose-response relationships.Furthermore,sex-stratified analyses were conducted to explore potential heterogeneity. All models were progressively adjusted for demographic, clinical, and metabolic confounders. Results: After multivariable adjustment, higher free triiodothyronine/free thyroxine(FT3/FT4) ratio and feedback quantile-based index(PTFQI) levels were independently associated with a lower risk of CHD. Compared with the lowest quartile, the odds ratios(OR) for the highest quartile were 0.29 for the FT3/FT4 ratio and 0.07 for PTFQI. RCS analyses revealed significant linear inverse associations between these indices and CHD risk. Sex-stratified analyses demonstrated that both FT3/FT4 ratio and PTFQI were significantly associated with CHD risk in male patients, whereas only higher thyrotroph thyroxine resistance index(TT4RI) was associated with increased risk in female patients. Conclusion: In euthyroidT2DM patients, higher peripheral and central thyroid hormone sensitivity are protective factors against CHD risk, exhibiting dose-response relationships. This protective association demonstrates significant sexual dimorphism, being primarily evident in male patients.

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