中国全科医学2025，Vol.28Issue(29)：3653-3659,7.DOI:10.12114/j.issn.1007-9572.2024.0629
甲状腺功能正常的2型糖尿病患者甲状腺激素敏感性指标与骨质疏松症的关系研究
Relationship between Thyroid Hormone Sensitivity Indices and Osteoporosis in Patients with Normal Thyroid Function Type 2 Diabetes Mellitus
摘要
Abstract
Background With the increasing aging population,the prevalence of osteoporosis in patients with type 2 diabetes mellitus(T2DM)is rising year by year.It has also been found that impaired sensitivity to thyroid hormone is associated with abnormal bone metabolism.However,there are few studies on the relationship between thyroid hormone sensitivity and the risk of osteoporosis in patients with T2DM.Objective To analyze the relationship between thyroid hormone sensitivity index and osteoporosis in T2DM patients with normal thyroid function.Methods This cross-sectional study included 723 T2DM patients with normal thyroid function admitted to the Department of Endocrinology of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from 2022 to 2023.Based on the results of bone mineral density(BMD)measurements,the patients were divided into three groups:normal bone mass group(n=362),osteopenia group(n=291),and osteoporosis group(n=70).The thyroid feedback quotient index(TFQI),thyroid-stimulating hormone index(TSHI),thyroid-stimulating hormone resistance index(TT4RI),and the ratio of free triiodothyronine to free thyroxine(FT3/FT4)were measured and calculated in each patient to assess thyroid hormone sensitivity.One-way analysis of variance(ANOVA)and chi-square test were used for intergroup comparisons.Spearman's rank correlation analysis and ultivariate Logistic regression analysis were employed to explore the association between thyroid hormone sensitivity indices and the risk of osteoporosis in T2DM patients.The receiver operating characteristic curve(ROC curve)was used to evaluate the value of TFQI in predicting osteoporosis Results The osteoporosis group had higher age,proportion of females,diabetes duration,systolic blood pressure,2-hour postprandial glucose(2 hPG),high-density lipoprotein cholesterol(HDL-C),and TFQI compared with the normal bone mass group(P<0.05).In contrast,BMI,alanine aminotransferase(ALT),diastolic blood pressure,creatinine,triglycerides,FT3,and FT3/FT4 were lower in the osteoporosis group than in the normal bone mass group(P<0.05).The osteoporosis group also had higher age,proportion of females,diabetes duration,systolic blood pressure,2 hPG,HDL-C,and TFQI compared with the osteopenia group(P<0.05),while ALT,creatinine,triglycerides,FT3,and FT3/FT4 were lower(P<0.05).Spearman rank correlation analysis showed that the occurrence of osteoporosis in T2DM patients was positively correlated with TFQI(rs=0.553,P<0.001)and negatively correlated with FT3 and FT3/FT4(rs=-0.098,P=0.009;rs=-0.080,P=0.031).Multivariate Logistic regression analysis revealed that,after adjusting for confounding factors,TFQI was positively associated with the risk of osteoporosis in T2DM patients(OR=6.612,95%CI=5.793-8.192,P<0.05).The area under the ROC curve(AUC)for predicting the risk of osteoporosis in T2DM patients using TFQI was 0.831(95%CI=0.794-0.867),with a best cutoff value of-0.029.The sensitivity and specificity were 100.0%and 55.4%,respectively.Conclusion Elevated levels of TFQI are associated with a higher risk of osteoporosis in T2DM patients with normal thyroid function,suggesting that reduced central sensitivity to thyroid hormone in this population is related to the development of osteoporosis.关键词
糖尿病,2型/骨质疏松/骨密度/甲状腺/甲状腺激素类/预测Key words
Diabetes mellitus,type 2/Osteoporosis/Bone mineral density/Thyroid gland/Thyroid hormones/Forecasting分类
医药卫生引用本文复制引用
张媛,陈冠华,吕珊珊,荆亚莉..甲状腺功能正常的2型糖尿病患者甲状腺激素敏感性指标与骨质疏松症的关系研究[J].中国全科医学,2025,28(29):3653-3659,7.基金项目
国家自然科学基金资助项目(82374554) （82374554）
南京鼓楼医院2024年临床研究项目(2024-LCYJ-ZXY-02) （2024-LCYJ-ZXY-02）
