The Study Of Thyroid Stimulating Hormone Effect On Audition Of Patients With Type 2 Diabetes

Objective:To investigate the relationship between subclinical hypothyroidism（SCH）and hearing of type 2 diabetes,to reveal the effects of thyroid stimulating hormone on hearing of type 2 diabetes,and to provide clinical theoretical basis for early intervention of T2DM patients with SCH.Methods:The clinical data of 100 patients（200 ears）treated in the First Hospital of Lanzhou University from January 2018 to November 2019 were collected,including gender,age,blood pressure,diabetes course,HbA1c,FPG,TC,TG,LDL-C,HDL-C,HCY,hs-CRP,TSH,FT₃,FT₄ and the hearing threshold of both ears at different frequencies.All patients were divided into two groups with TSH 4.94 uIU/ml as the cut-off point,including 45 cases in the T2DM group（TSH≤4.94u IU/ml）and 55cases in the T2DM+SCH group（TSH>4.94 uIU/ml）.Clinical data of the two groups were compared,and spearman correlation analysis was used to analyze the correlation between TSH,FT₃,FT₄ and gender,age,blood pressure,diabetes course,HbA1c,FPG,TC,TG,LDL-C,HDL-C,HCY,hs-CRP.Taking gender,age,BMI,TSH,blood lipids as independent variables,and whether combined with hearing impairment as the dependent variable,regression analysis was used to explore possible risk factors for hearing impairment in type 2 diabetes.All data were statistically analyzed using SPSS version 26.0.Results:1.Clinical characteristics of study subjects:（1）The differences between TC,TG,LDL-C,HCY,hs-CRP and other indicators in the two groups of patients were statistically significant（P<0.05）,and the above indicators in the T2DM+SCH group are significantly higher than those in the T2DM group;（2）The differences between FT₄ and HDL-C in the two groups were statistically significant（P<0.05）,and the above two indicators in the T2DM+SCH group are significantly lower than those in the T2DM group;（3）There were no significant differences in gender,age,duration of diabetes,systolic blood pressure,diastolic blood pressure,BMI,HbA1c,FPG,and FT₃ between the T2DM group and the T2DM+SCH group（P>0.05）.2.Pure tone audiometry results of left and right ears of patients in T2DM group and T2DM+SCH group（1）Compared with the left ear hearing threshold,the difference between the T2DM group and the T2DM+SCH group was statistically significant（P<0.05）.The left ear hearing threshold of the T2DM group was lower than the left ear hearing threshold of the T2DM+SCH group at various frequencies.（2）Compared with the right ear hearing threshold,the difference between the T2DM group and the T2DM+SCH group was statistically significant（P<0.05）.The right ear hearing threshold of the T2DM group was lower than the right ear hearing threshold of the T2DM+SCH group at all frequencies.3.Correlation analysis of TSH,FT₃,FT₄ and various factors（1）TSH was significantly correlated with the TC,TG,HDL-C,LDL-C,HCY,hs-CRP,average hearing threshold,and the correlation with age,gender,duration of diabetes,systolic blood pressure,diastolic blood pressure,BMI,HbA1c,FPG was not statistically significant.（2）There is a negative correlation between FT₃ and HbA1c;（3）There is a negative correlation between FT₄ and TG.4.Distribution of hearing impairment at various frequencies in different TSH ranges1)Distribution of hearing impairment in different TSH ranges（1）When TSH is less than 4.94 uIU/mL,20%is normal hearing,68.9%is high frequency hearing impairment,and 11.1%is middle and high frequency hearing impairment;（2）When TSH is between 4.94 and 10.00 uIU/mL,9.5%is normal hearing,83.3%is high frequency hearing impairment,and 7.2%is middle and high frequency hearing impairment;（3）When TSH is greater than 10 uIU/mL,38.4%are high frequency hearing impairment,30.8%are middle and high frequency hearing impairment,and 30.8%are low,middle and high frequency hearing impairment.2)Distribution of hearing impairment at different frequencies（1）When TSH is less than 4.94 uIU/mL,20%is normal hearing,68.9%is high frequency hearing impairment,and 11.1%is middle and high frequency hearing impairment;（2）When TSH is between 4.94 and 10.00 uIU/mL,9.5%is normal hearing,83.3%is high frequency hearing impairment,and 7.2%is middle and high frequency hearing impairment;（3）When TSH is greater than 10 uIU/mL,38.4%are high frequency hearing impairment,30.8%are middle and high frequency hearing impairment,and 30.8%are low,middle and high frequency hearing impairment.5.Regression analysis of risk factors for hearing impairment in type 2 diabetes1)Logistic regression analysis:（1）TSH is a risk factor for hearing loss in patients with type 2 diabetes（P=0.043,OR=1.834）,suggesting that the risk of hearing impairment in patients with abnormal TSH is 1.834 times that of patients with normal thyroid function;（2）TG is a risk factor for hearing loss in patients with type 2 diabetes（P=0.040,OR=5.951）,suggesting that patients with abnormal TG have a 5.951 times higher risk of hearing impairment than patients with normal TG;（3）HDL-C is a protective factor for hearing loss in patients with type 2 diabetes（P=0.004）,suggesting that patients with higher HDL-C are less likely to have hearing impairment.（4）There was no significant correlation between gender,age,duration of diabetes,BMI,HbA1c,FPG,TC,LDL-C,HCY,hs-CRP and hearing impairment in patients with type 2 diabetes（P>0.05）.2)Multiple linear regression analysis:（1）TSH is a risk factor for hearing in patients with type 2 diabetes（P<0.001）,and HDL-C is a protective factor for hearing in patients with type 2 diabetes（P<0.001）;（2）There was no significant correlation between TG and hearing impairment in patients with type 2 diabetes（P>0.05）.Conclusion:TSH is one of the risk factors for hearing loss in patients with T2DM,so early intervention is needed.In addition,for patients with type 2 diabetes,HDL-C is a protective factor for hearing,TG may be a risk factor for hearing impairment.There was no significant correlation between age,duration of diabetes,BMI,TG,LDL-C,HCY,hs-CRP and hearing in patients with type 2 diabetes.These findings suggest that early intervention with SCH can prevent hearing loss in T2DM.