甲状腺功能正常的2型糖尿病患者中血清spexin、TSH水平与周围神经病变的相关性

doi:10.3969/j.issn.1004-583X.2026.06.008

摘要/Abstract

摘要：

目的分析甲状腺功能正常的2型糖尿病(type 2 diabetes mellitus,T2DM)患者中血清神经肽(spexin)、促甲状腺激素(Thyroid Stimulating Hormone,TSH)水平与糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的相关性。方法回顾性分析2025年1月-2025年12月于郑州大学第五附属医院内分泌科住院的T2DM患者391例,合并存在DPN患者184例(研究组),排除DPN患者207例(对照组)。所有患者均完善甲状腺功能检验,结果为正常。收集两组临床资料、生化指标,多因素logistic回归分析T2DM患者合并DPN的危险因素,并通过受试者临床特征曲线(ROC)分析spexin、TSH对DPN的预测价值。结果与对照组比,研究组具有较低的身体质量指数(body mass index,BMI)和血清spexin水平,差异有统计学意义(t=3.671,6.902,P<0.05);研究组糖尿病病程、糖化血红蛋白A₁c(HbA₁c)、甘油三酯(TG)、TSH、同型半胱氨酸(homocysteine、Hcy)均高于对照组,差异有统计学意义(P<0.05)。Logistic回归分析显示,糖尿病病程、HbA₁c、TSH、spexin均是T2DM并发DPN的独立危险因素(P<0.05)。ROC曲线分析提示:血清spexin、TSH预测T2DM患者并发DPN的曲线下面积分别为0.685、0.713;两者联合预测的曲线下面积为0.749,高于单一检测指标(P<0.05)。结论甲状腺功能正常T2DM患者中,血清spexin、TSH是T2DM并发DPN的独立危险因素,两者联合检测对于T2DM是否合并DPN具有一定的预测价值。

关键词: 糖尿病,2型, 甲状腺激素, 糖尿病神经病变, spexin

Abstract:

Objective To analyze the association of serum spexin and thyroid-stimulating hormone (TSH) levels with diabetic peripheral neuropathy (DPN) in euthyroid patients with type 2 diabetes mellitus (T2DM). Methods A retrospective analysis was performed on 391 patients with T2DM hospitalized in the Department of Endocrinology of the Fifth Affiliated Hospital of Zhengzhou University from January 2025 to December 2025. Among them, 184 patients with DPN were included in the study group, and 207 patients without DPN were included in the control group. Thyroid function tests were completed in all patients, and the results were normal. Clinical data and biochemical indicators were collected for both groups. Multivariate logistic regression was used to identify risk factors for DPN in patients with T2DM, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of spexin and TSH for DPN. Results Compared with the control group, the study group had lower body mass index (BMI) and serum spexin levels, and the differences were statistically significant (t=3.671, 6.902, P<0.05). In the study group, diabetes duration, glycated hemoglobin A₁c (HbA₁c), triglycerides (TG), TSH, and homocysteine (Hcy) were all higher than those in the control group, with statistically significant differences (P<0.05). Logistic regression analysis showed that diabetes duration, HbA₁c, TSH, and spexin were independent risk factors for DPN in patients with T2DM (P<0.05). ROC analysis showed that the areas under the curve(AUC) for serum spexin and TSH in predicting DPN in patients with T2DM were 0.685 and 0.713, respectively. The AUC for their combined prediction was 0.749, which was higher than that of either marker alone (P<0.05). Conclusion In euthyroid patients with T2DM, serum spexin and TSH are independent risk factors for DPN. Combined detection of these two markers has certain predictive value for identifying whether T2DM is complicated by DPN.

Key words: diabetes mellitus, type 2, thyroid hormone, diabetic neuropathies, spexin

中图分类号:

R587.1

田晓菲, 饶小娟, 史双伟, 方一凡. 甲状腺功能正常的2型糖尿病患者中血清spexin、TSH水平与周围神经病变的相关性[J]. 临床荟萃, 2026, 41(6): 529-533.

Tian Xiaofei, Rao Xiaojuan, Shi Shuangwei, Fang Yifan. Association of serum spexin and TSH levels with peripheral neuropathy in euthyroid patients with type 2 diabetes mellitus[J]. Clinical Focus, 2026, 41(6): 529-533.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.06.008

https://www.lchc.cn/CN/Y2026/V41/I6/529

图/表 4

参考文献 22

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项目	研究组(n=184)	对照组(n=207)	χ²/t值	P值
性别[例(%)]
男女	103(55.97) 81(44.03)	116(56.04) 91(43.96)	0.877	0.682
吸烟史[例(%)]
有无	78(42.39) 106(57.61)	87(42.03) 120(57.97)	0.747	0.604
饮酒史[例(%)]
有无	56(30.43) 128(69.57)	67(32.37) 140(67.63)	1.582	0.792
高血压病史[例(%)]
有无	45(24.45) 139(75.54)	54(26.09) 153(73.91)	1.374	0.839
冠心病病史[例(%)]
有无	38(20.65) 146(79.35)	46(22.22) 161(77.78)	0.975	0.683
年龄(岁)	54.23±2.83	55.61±1.92	0.832	0.581
BMI(kg/m²)	24.63±3.81	26.09±2.74	3.671	0.017
病程(年)	6.72±1.84	5.93±1.30	3.374	0.020
HbA₁c(%)	9.43±0.73	8.84±1.02	5.820	<0.01
TC(mmol/L)	5.06±0.73	5.01±1.04	0.783	0.621
TG(mmol/L)	2.84±0.71	2.31±0.63	3.091	0.008
HDL-C(mmol/L)	1.53±0.17	1.94±0.36	0.904	0.391
LDL-C(mmol/L)	2.47±0.61	2.03±0.59	0.893	0.402
FT3(pmol/L)	4.52±0.93	4.38±0.72	0.594	0.702
FT4(pmol/L)	13.61±2.31	14.78±1.92	0.792	0.571
TSH(mU/L)	2.75±0.27	1.67±0.39	4.782	<0.01
SUA(μmol/L)	324.82±40.92	321.04±51.20	0.582	0.681
Hcy(μmol/L)	16.72±2.05	13.02±2.94	2.943	0.019
血清spexin(μg/L)	0.89±0.20	1.25±0.19	6.902	<0.01

项目	研究组(n=184)	对照组(n=207)	χ²/t值	P值
性别[例(%)]
男女	103(55.97) 81(44.03)	116(56.04) 91(43.96)	0.877	0.682
吸烟史[例(%)]
有无	78(42.39) 106(57.61)	87(42.03) 120(57.97)	0.747	0.604
饮酒史[例(%)]
有无	56(30.43) 128(69.57)	67(32.37) 140(67.63)	1.582	0.792
高血压病史[例(%)]
有无	45(24.45) 139(75.54)	54(26.09) 153(73.91)	1.374	0.839
冠心病病史[例(%)]
有无	38(20.65) 146(79.35)	46(22.22) 161(77.78)	0.975	0.683
年龄(岁)	54.23±2.83	55.61±1.92	0.832	0.581
BMI(kg/m²)	24.63±3.81	26.09±2.74	3.671	0.017
病程(年)	6.72±1.84	5.93±1.30	3.374	0.020
HbA₁c(%)	9.43±0.73	8.84±1.02	5.820	<0.01
TC(mmol/L)	5.06±0.73	5.01±1.04	0.783	0.621
TG(mmol/L)	2.84±0.71	2.31±0.63	3.091	0.008
HDL-C(mmol/L)	1.53±0.17	1.94±0.36	0.904	0.391
LDL-C(mmol/L)	2.47±0.61	2.03±0.59	0.893	0.402
FT3(pmol/L)	4.52±0.93	4.38±0.72	0.594	0.702
FT4(pmol/L)	13.61±2.31	14.78±1.92	0.792	0.571
TSH(mU/L)	2.75±0.27	1.67±0.39	4.782	<0.01
SUA(μmol/L)	324.82±40.92	321.04±51.20	0.582	0.681
Hcy(μmol/L)	16.72±2.05	13.02±2.94	2.943	0.019
血清spexin(μg/L)	0.89±0.20	1.25±0.19	6.902	<0.01

因素	β值	S.E值	Waldχ²值	OR值	95%CI	P值
病程(年)	0.078	0.021	13.629	1.072	1.030~1.115	<0.01
HbA₁c(%)	0.185	0.062	8.045	1.162	1.032~1.329	<0.01
TSH (mU/L)	0.352	0.073	22.405	1.389	1.204~1.526	<0.01
血清spexin (μg/L)	-0.183	0.018	15.824	1.043	0.971~1.203	<0.01

因素	β值	S.E值	Waldχ²值	OR值	95%CI	P值
病程(年)	0.078	0.021	13.629	1.072	1.030~1.115	<0.01
HbA₁c(%)	0.185	0.062	8.045	1.162	1.032~1.329	<0.01
TSH (mU/L)	0.352	0.073	22.405	1.389	1.204~1.526	<0.01
血清spexin (μg/L)	-0.183	0.018	15.824	1.043	0.971~1.203	<0.01

指标	最佳截断值	AUC	95%CI	敏感度	特异度	P值
spexin(μg/L)	1.03	0.685	0.572~0.741	0.642	0.684	<0.01
TSH(mU/L)	2.67	0.713	0.569~0.783	0.628	0.718	0.002
联合检测		0.749	0.592~0.801	0.682	0.739	<0.01