2型糖尿病患者甲状腺激素水平的变化及分析

Changes of Thyroid Hormones Level in Patients with Type 2 Diabetes Mellitus

目的通过比较2型糖尿病(T2DM)患者及健康人群血清甲状腺激素水平的变化,探讨该变化的临床意义。方法随机入选门诊T2DM患者及健康体检者,检测其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)、甲状腺彩超及甲状腺激素水平,选取以上检查均正常者入选本研究。T2DM患者还测定糖化血红蛋白(HbA1c)、空腹血糖(FPG)、糖化血清蛋白(GA)。T2DM患者按HbA1c是否大于7%分为控制不佳组与控制良好组,每组各120例。选取健康体检者120例,作为正常对照组。分析对比各组受检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)甲状腺激素水平:控制不佳组与控制良好组及正常对照组相比,三碘甲腺原氨酸(T3)及游离三碘甲腺原氨酸(FT3)均显著降低,差异有统计学意义(T3:P值分别为0.031和<0.001;FT3:P值分别为0.039和<0.001)。控制良好组与正常对照组相比,T3及FT3显著降低,差异有统计学意义(T3:P值为0.013;FT3:P值为0.043)。(2)双变量相关分析显示,T2DM患者T3及FT3与FPG、GA、HbA1c及病程呈线性负相关(T3:r值分别为-0.202、-0.215、-0.245及-0.266,P<0.05;FT3:r值分别为-0.182、-0.205、-0.264及-0.368,P<0.05)。(3)多元逐步回归分析显示,病程和HbA1c是影响T2DM患者FT3及T3的独立危险因素。结论 T2DM患者的T3及FT3已有不同程度降低,T2DM患者血清甲状腺激素水平的测定可反映其糖代谢紊乱的程度。

Objective To compare the changes of serum thyroid hormones level in patients with type 2 diabetes mellitus（T2DM）and healthy people,in order to find out the clinical significance of the changes.Methods The T2DM patients from outpatient departments of Endocrinology Departments were randomly recruited.Their thyroid peroxidase antibodies（TPOAb）,thyroid globulin antibody（TGAb）,thyroid-stimulating adrenaline receptor antibodies（TRAb）,and thyroid hormones were assayed,and thyroid color Dopplar ultrasonography was performed for them.Glycosylated hemoglobin A1c（HbA1c）,fasting plasma glucose（FPG）,glycated albumin（GA） were additionally given for T2DM patients.According to their HbA1c level the T2DM patients were divided into non-better control of glucose group（n=120,whose HbA1c7%） and better control of glucose group（n=120,whose HbA1c≤7%）.And 120 healthy people were recruited as control group.The difference of thyroid hormone levels in each group and the impact factors to thyroid hormones in T2DM patients were analyzed.Results（1） T3 and FT3 levels in the non-better control of glucose group were significantly lowered as compared with those in the better control of glucose group and control group（T3：P=0.031 and 0.001;FT3：P=0.039 and0.001）.And T3 and FT3 levels in the better control of glucose group were significantly lowered as compared with those in the control group（T3：P=0.013;FT3：P=0.043）.（2） Bi-variate correlation statistics showed that T3 and FT3 had a linear negative correlation with FBG,GA,HbA1c and the course of disease（T3：r=-0.202,-0.215,-0.245 and-0.266 respectively,P〈0.05;FT3：r=-0.182,-0.205,-0.264 and-0.368 respectively,P〈0.05）.（3）Multivariate stepwise Logistic regression analysis showed that the course of disease and HbA1c was an independent risk factor of FT3 and T3 in T2DM patients.Conclusion Thyroid hormones level in T2DM patients reflects the degree of glucose metabolism disorder.