2型糖尿病合并甲状腺功能减退对动脉粥样 硬化影响的研究进展

Research Progress on the Effect of Hypothyroidism on Atherosclerosis in Patients with Type 2 Diabetes Mellitus

摘要: 2型糖尿病(T2DM)与甲状腺功能减退症均为常见的慢性代谢性疾病。现有研究提示，二者共存时可能通过胰岛素抵抗加重、脂质代谢紊乱、内皮功能障碍、氧化应激及慢性低度炎症等途径，协同促进动脉粥样硬化(AS)的发生发展，并增加心血管不良事件风险。与单纯T2DM相比，合并甲状腺功能减退，尤其是亚临床甲状腺功能减退(SCH)时，患者的代谢异常和血管损伤可能进一步加重，但现有证据主要来源于观察性研究和机制研究，其因果关系及干预获益尚需进一步明确。本文从发病机制、临床相关性及药物影响三方面综述T2DM合并甲状腺功能减退对AS的影响。

Abstract: Type 2 diabetes mellitus (T2DM) and hypothyroidism are both common chronic metabolic disorders. Current evidence suggests that their coexistence may synergistically promote the development and progression of atherosclerosis (AS) through mechanisms such as exacerbated insulin resistance, dysregulated lipid metabolism, endothelial dysfunction, oxidative stress, and chronic low-grade inflammation, thereby increasing the risk of adverse cardiovascular events. Compared with T2DM alone, patients with concomitant hypothyroidism—particularly those with subclinical hypothyroidism (SCH)—may experience further aggravation of metabolic abnormalities and vascular injury. However, the available evidence is primarily derived from observational and mechanistic studies, and the causal relationship as well as the benefits of intervention remain to be clarified. This review summarizes the impact of T2DM combined with hypothyroidism on AS from three perspectives: pathogenic mechanisms, clinical relevance, and pharmacological interventions.