Effect Of Subclinical Hypothyroidism On Islet Function And Risk Of Coronary Heart Disease In Diabetic Patients

Objective:This topic will screen thyroid function in hospitalized diabetic patients,observe the abnormal thyroid function in diabetic patients,understand the possible influencing factors of diabetes with thyroid dysfunction,and explore potential effect of subclinical hypothyroidism on islet function and risk of coronary heart disease in diabetic patients,in order to provide a strong basis for clinical work.Methods:In this experiment,2023 cases of diabetic patients(including diabetics who lived in89 counties and cities in Shanxi Province for a long time)were collected from January2015 to January 2017 in Shanxi Provincial People’s Hospital.The patient’s basic information was obtained by reading medical records,collect relevant laboratory test indicators.According to the status of thyroid function is divided into hypothyroidism group,subclinical hypothyroidism group,hyperthyroidism group and normal group,a single factor analysis of the factors between the four groups;Diabetes with subclinical hypothyroidism were case group,diabetic patients with normal thyroid function were the control group.A multi-factor non-conditional logistic regression model was used to progressively screen risk factors one by one.Under the control of other factors,the correlation of subclinical hypothyroidism in diabetic patients was analyzed.The analysis index included the OR of each risk factor and its 95% CI.P<0.05 was considered statistically significant.Results:1.Diabetic population accounted for 19.57% of thyroid dysfunction,hypothyroidism was 1.73%,subclinical hypothyroidism was 15.07%,hyperthyroidism was 0.84%,subclinical hyperthyroidism was 1.93%,In the physical examination population,the total proportion of abnormal thyroid function was 8.98%,hypothyroidism was 0.67%,subclinical hypothyroidism was 6.7%,hyperthyroidism was 1.07%,and subclinical hyperthyroidism was 0.54%.2.Compared with the normal thyroid function group,the patients with hypothyroidism had significantly higher insulin treatment(P<0.05);Compared with the normal group,the probability of coronary heart disease in the hypothyroid minus group was significantly higher,and the difference was statistically significant(P<0.05).The proportion of women in the subclinical hypothyroidism group was significantly higher than that in the normal group(51.5%∽37.5%,P<0.001),and the average age of the subclinical hypothyroidism group was significantly higher than that of the normal group(P<0.001).Compared with the hypothyroid and subclinical hypothyroidism group,the TC level in the hyperthyroidism group was significantly lower(P<0.05).The evaluation glomerular filtration rate in the subclinical hypothyroidism group was significantly lower than that in the normal group(P<0.001).Compared with the normal group,the hypothyroidism group and The positive rate of TPO-Ab in subclinical hypothyroidism group was significantly higher(P<0.001).Compared with the normal group,the positive rate of TM-Ab in hyperthyroidism group was significantly higher(P < 0.05).Compared with the normal group,the HbA1 c level in the subclinical hypothyroidism group was significantly higher(P<0.05).The other indicators were not statistically different between the four groups and between the two groups(P>0.05).3.Correlation analysis found that TSH was positively correlated with age,gender,BMI,TG,TC,LDL,TPO-Ab,FINS,PINS,PCP,duration of diabetes,diabetes treatment,coronary heart disease,and negatively correlated with eGFR.FT4 is positively correlated with glycated hemoglobin and negatively correlated with islet beta cell function.FT3/FT4 is positively correlated with glycated hemoglobin and positively correlated with islet beta cell function.4.compared with the normal group,the female occupation ratio in subclinical hypothyroidism group was significantly higher than that in the normal group(P < 0.001),and the average age of the subclinical hypothyroidism group was significantly higher than that of the normal group(P < 0.001),and the BMI level in subclinical hypothyroidism group was significantly higher than that in the normal group(P < 0.05).The subclinical hypothyroidism group eGFR was significantly lower than the normal group(P < 0.001).Compared with the normal group,the TPO-Ab positive rate in subclinical hypothyroidism group was significantly higher(P < 0.001).Compared with the normal group,the incidence of coronary heart disease in subclinical hypothyroidism group was significantly higher(P < 0.001).Compared with the normal group of thyroid work,the HbA1 c level in the subclinical hypothyroidism group was significantly higher(P<0.05).Compared with the normal group,the duration of diabetes in subclinical hypothyroidism group was longer(P < 0.05).There was no significant difference between the two groups(P > 0.05).5.After multivariate regression analysis,the risk of SCH in diabetics increased with age [OR(95%CI)=1.028(1.014-1.042),P<0.001],and TPO-Ab positive is an independent risk factor for the occurrence of SCH[OR(95%CI)=2.284(1.601-3.260),P<0.001],TC is an independent risk factor for SCH in diabetics [OR(95%CI)=1.181(1.025-1.361),P=0.021],diabetic patients with coronary heart disease were more likely to develop SCH[OR(95% CI)=1.983(1.246~2.922),P=0.004].Conclusion:1.The probability of abnormal thyroid function in diabetics is more than two times that of the general population,among which diabetes has the highest proportion of SCH,which is 15.07%,suggesting the necessity of thyroid function screening in diabetics.2.Patients with diabetes,older age,high BMI,and long duration of diabetes are more likely to have SCH.3.FT4 is negatively related to islet beta cell function,and FT3/FT4 is positively related to islet beta cell function.4.Old age,TPO-Ab positive,hypercholesterolemia,and coronary heart disease were independent risk factors for SCH in people with diabetes,and thyroid function was monitored in people with these risk factors.