胰岛素治疗2型糖尿病患者甲状腺激素水平与抑郁情绪的相关性研究

Relativity study of thyroid hormone levels and depression mood in type 2 diabetes patients with insulin treatment

目的观察胰岛素强化治疗前后糖尿病患者抑郁情绪变化及与血清甲状腺激素水平的相关性。方法选择340例2型糖尿病患者（T2DM），其中187例给予胰岛素强化治疗3个月，153例给予口服降糖药治疗，对人选患者治疗前后进行抑郁测定，化验其血糖、糖化血红蛋白（HbAlc）、血清甲状腺激素，并进行统计学处理。治疗期间空腹血糖（FPG）控制在4．4mmol／L～6．1mmol／L，餐后2h血糖（2hPG）控制在4．4mmol／L-8．0mmol／L之间。结果胰岛素治疗前合并抑郁情绪的糖尿病患者甲状腺激素水平[分别为：甲状腺素（T4）（6．1±1．4）μg/dl，三碘甲状腺原氨酸（L）（O．98±0．26）ng／ml]均低于无抑郁情绪的患者[T4（8．4±1．7）μg/dl，L（1．51±0．29）ng／m1]（P〈0．01），促甲状腺激素（TSH）水平[（4．5±1．1）ulU／m1]高于无抑郁情绪者[（1．9±0．9）uIU／ml]（P〈0．01）；胰岛素治疗后合并抑郁情绪的患者抑郁指数为（0．51±0．12）较治疗前明显降低（0．68±0．21）（P〈0．01），L、T。水平明显升高[分别为：L（1．38±0．28）ng／ml，T4（7．7±1．5）μg/dl]（P〈0．01），TSH水平明显降低[（2．1±1．2）uIU／m1]（P〈0．01）。治疗前抑郁指数与T4、T3呈负相关（r=-0．468、-0．511，P〈0．05），与TSH呈正相关（r=0．583，P〈0．01）；胰岛素组治疗后抑郁指数下降与T3、T4升高呈显著正相关（r=0．395、0．337，P〈0．05），与TSH下降呈负相关（r=-0．239，P〈0．05），而口服降糖药组治疗前后抑郁指数及甲状腺激素水平无明显变化。结论胰岛素治疗后2型糖尿病患者抑郁情绪的改善与甲状腺激素水平相关。

Objective To observe the correlation of mood changes and serum levels of thyroid hormone in patients with diabetes and depression mood before and after intensive insulin therapy. Methods 340 patients with type 2 diabetes （T2DM） were enrolled, of which 187 cases were given intensive insulin therapy for 3 months and the other 153 cases were treated with oral hypoglyeemie. All patients reeeived depression measurement and tests of blood glucose, glycated hemoglobin （HbAlc）, serum thyroid hormones before and after treatment. The data were analyzed statistieally. Dining the treatment, fasting plasma glucose was controlled in （4.4 - 6. 1 ） mmol/L and 2-hour postprandial plasma glucose was controlled in （4.4 - 8.0） mmol/L. Results Thyroid hor- mone levels in the diabetic patients with depression mood （ T4 （ 6.1± 1.4 ） μg/dl, T3 （ 0.98 ± 0.26） ng/ml ） were all lower than that in without depression mood （ T4 （ 8.4 ± 1.7 ） μg/dl, T3 （ 1.51 -＋ 0.29 ） ng/ml） （P 〈 0. 01 ） , and TSH （4.5 ± 1.1 ） were higher than that in without depression mood（ 1.9 ±0.9） ulU/ml （P 〈 0.01 ） before insulin treatment. After insulin therapy depression degree （0.51 ± 0.12 ） were decreased significantly （0.68 ± 0.21 ） （P 〈 0.01 ）, and thyroid hormone levels were significantly increased（ T3 （1.38 ± 0.28 ）ng/ml ,T4 （7.7 - 1.5 ）μg/dl）, and TSH levels were significantly reduced （ （2.1 ± 1.2 ） ulU/ml） （P 〈 0.01 ） than that before insulin therapy in the patients combined with depression mood. Depression degree was significantly negative correlated with T4 and T3 （ r = - 0. 468, - 0.511 , P 〈 0.05 ） and significantly positive correlated with TSH （ r = 0. 583, P 〈 0. Ol ） before treatment. Decline of depression degree were significantly positive correlated with elevation of T3 , T4 levels （ r = 0. 395,0. 337, P〈 0.05 ） and were significantly negative correlated with decrease of TSH levels （ r = -0. 239, P〈 0.05） after insulin treatment. However, depression degree and thyroid hormone levels did not significantly change before and after in oral antihyperglycemic agents groups. Conclusion hnprovement of depression was associated with thyroid hormone levels in type 2 diabetic patients after insulin therapy.