Correlation between diabetic peripheral neuropathy and thyroid hormone sensitivity in elderly patients with type 2 diabetes mellitus.

IF 4.6 3区医学 Q1 ENDOCRINOLOGY & METABOLISM World Journal of Diabetes Pub Date : 2025-02-15 DOI:10.4239/wjd.v16.i2.98897

Si-Jia Fei, Jing-Yi Luo, Wei-Hao Wang, Li-Xin Guo, Qi Pan

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Abstract

Background: Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (T2DM), significantly affecting patients' quality of life and imposing a substantial economic burden. Recent studies have highlighted the role of thyroid hormones in diabetes complications, particularly in elderly patients with T2DM. However, the relationship between thyroid hormone sensitivity and DPN remains unclear.

Aim: To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.

Methods: In a cohort of 256 elderly patients with T2DM, propensity score matching was used to balance age, sex, and diabetes duration. Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN. A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine (FT₃/FT₄) for DPN.

Results: Patients with DPN had a lower FT₃/FT₄ ratio [ (0.302 ± 0.053) vs (0.316 ± 0.049), P = 0.040]. Quartile stratification showed decreasing DPN prevalence with higher FT₃/FT₄ ratios. Spearman's correlation analysis showed that a lower FT₃/FT₄ ratio was associated with higher glycated hemoglobin, fasting blood glucose, reduced nerve conduction velocity, and electrical skin conductance. Logistic regression indicated a positive relationship between the median FT₃/FT₄ ratio and bilateral foot electrochemical skin conductance [odds ratio (OR): 1.019; 95%CI: 1.005-1.034; P = 0.007] and sural nerve sensory amplitude (OR: 1.310; 95%CI: 1.008-1.703; P = 0.043). Receiver operating characteristic analysis using a random forest model showed that incorporating FT₃/FT₄ improved predictive performance for DPN, with an area under the curve of 0.74, sensitivity of 0.79, specificity of 0.64, and accuracy of 0.77.

Conclusion: In elderly patients with T2DM with euthyroidism, a lower FT₃/FT₄ ratio is correlated with increased DPN incidence, affecting both large and small nerve fibers. FT₃/FT₄ is an effective predictor of DPN.

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老年2型糖尿病周围神经病变与甲状腺激素敏感性的关系

背景：糖尿病周围神经病变（DPN）是2型糖尿病（T2DM）的常见并发症，严重影响患者的生活质量，给患者带来巨大的经济负担。最近的研究强调了甲状腺激素在糖尿病并发症中的作用，特别是在老年T2DM患者中。然而，甲状腺激素敏感性与DPN之间的关系尚不清楚。目的：探讨老年T2DM患者甲状腺激素敏感性与DPN的相关性。方法：在256例老年T2DM患者队列中，使用倾向评分匹配来平衡年龄、性别和糖尿病病程。收集临床资料计算甲状腺激素敏感性并分析其与DPN的相关性。采用随机森林模型评价游离三碘甲状腺原氨酸/游离甲状腺素（FT3/FT4）对DPN的诊断价值。结果：DPN患者FT3/FT4比值较低[(0.302±0.053)vs(0.316±0.049),P = 0.040]。四分位数分层显示，FT3/FT4比值越高，DPN患病率越低。Spearman相关分析显示，FT3/FT4比值较低与糖化血红蛋白升高、空腹血糖升高、神经传导速度降低、皮肤电导降低有关。Logistic回归结果显示，FT3/FT4比值中位数与双侧足部皮肤电导呈正相关[比值比（OR）： 1.019；95%置信区间:1.005—-1.034;P = 0.007]和腓肠神经感觉振幅(OR: 1.310；95%置信区间:1.008—-1.703;P = 0.043)。采用随机森林模型进行的受试者工作特征分析显示，合并FT3/FT4可提高DPN的预测性能，曲线下面积为0.74，灵敏度为0.79，特异性为0.64，准确率为0.77。结论：老年T2DM伴甲状腺功能亢进患者FT3/FT4比值较低与DPN发生率增高相关，大、小神经纤维均受影响。FT3/FT4是DPN的有效预测因子。

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来源期刊

World Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

自引率

2.40%

发文量

909

期刊介绍： The WJD is a high-quality, peer reviewed, open-access journal. The primary task of WJD is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of diabetes. In order to promote productive academic communication, the peer review process for the WJD is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJD are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in diabetes. Scope: Diabetes Complications, Experimental Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Diabetes, Gestational, Diabetic Angiopathies, Diabetic Cardiomyopathies, Diabetic Coma, Diabetic Ketoacidosis, Diabetic Nephropathies, Diabetic Neuropathies, Donohue Syndrome, Fetal Macrosomia, and Prediabetic State.