25羟维生素D、血脂指标与2型糖尿病患者合并甲状腺结节的相关性分析

Correlation Analysis of 25 Hydroxyvitamin D, Lipid Indexes and Thyroid Nodules in Patients with Type 2 Diabetic Mellitus

摘要: 目的：探讨血清25羟维生素D水平、血脂指标与2型糖尿病(Type 2 Diabetes Mellitus, T2DM)患者合并甲状腺结节(Thyroid Nodule, TN)的相关性。方法：收集2021年1月至2024年1月在陕西省人民医院主院区内分泌科住院治疗的276例患者的临床资料进行回顾性分析，按甲状腺影像报告和数据系统(TI-RADS)将TN进行分类，分为T2DM不合并TN组、T2DM合并TN (TI-RADS1、2)组、T2DM合并TN (TI-RADS3)组、T2DM合并TN (TI-RADS ≥ 4)组，比较4组患者的临床特征，采用Pearson相关性分析法分析血清25羟维生素D、血脂指标与T2DM患者合并TN的相关性，多元Logistic回归分析对T2DM患者合并TN有显著影响的因素。结果：276例T2DM患者中，2型糖尿病不合并甲状腺结节组63例(22.83%)、2型糖尿病合并甲状腺结节(TI-RADS1、2)组67例(24.28%)、2型糖尿病合并甲状腺结节(TI-RADS3)组78例(28.26%)及2型糖尿病合并甲状腺结节(TI-RADS ≥ 4)组68例(24.63%)。四组患者的性别、低密度脂蛋白胆固醇(LDL-C)水平比较差异无统计学意义(P > 0.05)，年龄、25(OH)D、糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、三酰甘油(TG)在四组间的差异有统计学意义(P < 0.05)。相关性分析显示，25(OH)D、HDL-C水平与T2DM患者TN分级呈负相关，TC、TG水平与T2DM患者TN分级呈正相关(P < 0.05)；年龄、HbA1c水平与T2DM患者TN分级无明显相关性(P > 0.05)。多元Logistic回归分析显示，25(OH)D、TG是预测T2DM患者合并TN及TN级别的独立危险因素。结论：血清25(OH)D、HDL-C水平与T2DM患者合并TN及其严重程度呈负相关，血清TC、TG水平与T2DM患者合并TN及其严重程度呈正相关。血清25(OH)D、TG水平可能是影响T2DM患者发生TN及TN严重程度的独立预测因素。

Abstract: Objective: To investigate the correlation between serum 25-hydroxyvitamin D levels, lipid indexes, and Thyroid Nodules (TN) in patients with Type 2 Diabetes Mellitus (T2DM). Methods: Clinical data of 276 patients hospitalized in the Department of Endocrinology at the main hospital district of Shaanxi Provincial People’s Hospital from January 2021 to January 2024 were collected and retrospectively analyzed. TN was classified according to the Thyroid Imaging Reporting and Data System (TI-RADS) into the group of T2DM without TN, and the group of T2DM combined with TN (TI-RADS1 and 2), T2DM combined with TN (TI-RADS3) group, and T2DM combined with TN (TI-RADS ≥ 4) group, comparing the clinical characteristics of patients in the four groups, using Pearson correlation analysis to analyze the correlation between serum 25 hydroxyvitamin D, lipid indexes and combined TN in patients with T2DM, and the factors with a significant effect on combined TN in patients with T2DM were analyzed multivariate Logistic regression. Results: Among 276 patients with T2DM, there were 63 cases (22.83%) in the group of type 2 diabetes mellitus without TN, 67 cases (24.28%) in the group of type 2 diabetes mellitus combined with TN (TI-RADS1 and 2), 78 cases (28.26%) in the group of type 2 diabetes mellitus combined with TN (TI-RADS3), and 68 cases (24.63%) in the group of type 2 diabetes mellitus combined with TN (TI-RADS ≥ 4). There was no statistically significant difference (P > 0.05) in the comparison of gender and Low-Density Lipoprotein Cholesterol (LDL-C) levels among the four groups, while age, 25(OH)D, glycosylated hemoglobin (HbA1c), High-Density Lipoprotein Cholesterol (HDL-C), total cholesterol (TC) and triacylglycerol (TG) showed statistically significant differences (P < 0.05) among the four groups. Correlation analysis showed that 25(OH)D and HDL-C levels were negatively correlated (P < 0.05) with TN grading in T2DM patients, while TC and TG levels were positively correlated (P < 0.05) with TN grading in T2DM patients; age and HbA1c levels showed no significant correlation (P > 0.05) with TN grading in T2DM patients. Multiple Logistic regression analysis showed that 25(OH)D and TG were independent risk factors for TN and TN grade in T2DM patients. Conclusions: Serum 25(OH)D and HDL-C levels were negatively correlated with combined TN and its severity in T2DM patients, while serum TC and TG levels were positively correlated with combined TN and its severity in T2DM patients. Serum 25(OH)D and TG levels may be independent predictors of TN and TN severity in T2DM patients.