糖代谢对甲状腺功能的影响

Influence of glucose metabolism on thyroid hormones value

目的调查糖尿病前期（pre—DM）患者、新发2型糖尿病（T2DM）患者和健康人群血清甲状腺激素的变化，探讨糖代谢与甲状腺功能之间的关系。方法随机入选门诊甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）、促甲状腺素受体抗体（TRAb）及甲状腺彩超均正常的新发T2DM患者（T2DM组）、糖尿病前期患者（Pre—DM组）和健康体检者（正常对照组）各60例，检测甲状腺激素含量。T2DM患者还检测糖化血红蛋白（HbA1C）、空腹血糖（FPG）、糖化血清蛋白（GA）。对比3组患者甲状腺激素水平的差异，并分析T2DM患者甲状腺激素的影响因素。结果（1）甲状腺激素：pre—DM组与正常对照组比较差异无统计学意义（P均〉0．05）。T2DM组三碘甲状腺原氨酸（L）[（1．34±0．24）nmol／L]及游离三碘甲状腺原氨酸（FT，）[（3．88±0．51）pmol／L]较pre—DM组[（1．48±0．29）nmol／L、（4．12±0．55）pmol／L]和正常对照组[（1．49±0．26）nmol／L、（4．13±0．55）pmol／L]显著降低（T3：t值为-0．135和-0．145，P均〈0．01；FT3：t值为-0．240和-0．260，P〈0．05或P〈0．01）。（2）T2DM组T3及耽与FIG、GA、HbA1C呈线性负相关（T3：r值分别为-0．275、-0．318、-0．453，P均〈0．05；FT3：r值分别为-0．280、-0．291、-0．336，P均〈0．05）。结论糖代谢异常患者仅在糖代谢达到一定的紊乱程度后，才会引起甲状腺激素的异常改变，从而表现出T3及FT3与血糖指标的负相关性。

Objective To compare the serum thyroid hormones level in patients with pre-diabetes, newly diagnosed type 2 diabetes mellitus （T2DM）and healthy people, and to investigate the association of glucose metabolism with thyroid function. Methods Sixty newly diagnosed T2DM patients （ T2DM group ）, 60 pre-diabetes patients（ pre-diabetes group）, and 60 healthy people （healthy group） from outpatient departments were randomly enrolled in the study. Their thyroid peroxidase antibodies（TPOAb）, thyroglobulin antibodies（ TGAb）, thyrotropin receptor antibodies （TRAb） , and thyroid color dopplar ultrasound were all normal. Thyroid hormones was measured. Glyeosylated hemoglobin A1 c （ HbA1 c ）, fasting plasma glucose （ FPG ）, glyeated albumin （ GA ） was additionally measured in T2DM patients. We compared the difference of thyroid hormones among the 3 groups and investigated the factors that influence thyroid hormones level in each T2DM patients. Results There was no significant difference found on thyroid hormones level between the pre-diabetes group and healthy group （P 〈 0. 05 ）. T3 and FT3 level were （ 1.34±0. 24 ） nmol/L and （ 3.88 ±0. 51 ） pmol/L in the T2DM group, respectively, which were significantly lower than those in the pre-diabetes group （ [ 1.48 ±0. 29 ] nmol/L and [4. 12 ±0. 55]pmol/L,t = -0. 135 and -0. 145 ,respectively,Ps 〈0. 01 ） and in the healthy group（ [ 1.49± 0. 26]nmol/L and [4. 13±0. 55] pmol/L,t = -0. 240 and -0. 260,respectively,P 〈0.05 or 0.01 ） . In the T2DM group, T3 and FT3 were negatively correlated with FPG, GA, HbA1c（ For T3 ： r = - 0. 275, - 0. 318 and - 0. 453, respectively, Ps 〈 0. 05 ; For FT3 ： r = - 0. 280, - 0. 291 and - 0. 336 , respectively, Ps 〈 0. 05）. Conclusion In patients with abnormal glucose metabolism, thyroid hormone was influenced only when the glucose metabolism level reached a certain abnormal degree.