2型糖尿病甲状腺激素水平与胰岛素抵抗的相关性研究

Research of correlation between thyroid hormones level and insulin resistance of type 2 diabetes mellitus

目的探讨非老年人群2型糖尿病(T2DM)患者甲状腺激素水平与胰岛素抵抗的相关性。方法 562例T2DM患者,根据胰岛素抵抗指数(HOMA-IR)的上1/4位点分为胰岛素抵抗组(396例)和非胰岛素抵抗组(166例)。空腹测量身高、体重,计算体质量指数(BMI);并静脉采血检测血糖(FPG)、胰岛素(INS)、糖化血红蛋白(Hb A1c)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、甘油三酯(TG)、总胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平。结果胰岛素抵抗组的BMI、Hb A1c、TSH、TG、LDL-C显著高于非胰岛素抵抗组(P<0.05);FT3、HDL-C显著低于非胰岛素抵抗组(P<0.01);性别、年龄、病程、FT4、CHOL两组间比较差异无统计学意义(P>0.05)。相关分析显示,HOMA-IR与BMI(r=0.349,P<0.001)、TSH(r=0.459,P<0.001)、TG(r=0.191,P<0.001)、LDL-C(r=0.114,P=0.037)呈显著正相关;与FT3(r=-0.239,P<0.001)、HDL-C(r=-0.106,P=0.041)呈显著负相关;与Hb A1c(r=0.067,P=0.219)无相关性。在校正了混杂因素后,HOMA-IR与FT3(r=-0.179,P=0.001)和TSH(r=0.297,P<0.001)独立相关。结论 T2DM患者胰岛素抵抗与甲状腺激素水平有关,且共同影响脂质代谢;低三碘甲状腺原氨酸(T3)可能是机体过度消耗的保护机制,高TSH可能加重了T2DM胰岛素抵抗的进展。

Objective To investigate the correlation between thyroid hormones level and insulin resistance of non-senile type 2 diabetes mellitus （T2DM） patients.Methods A total of 562 T2DM patients were divided into insulin resistance group （n=396） and non-insulin resistance group （n=166） according to their 1/4 locus of homeostasis model assessment of insulin resistance （HOMA-IR）. Patient’s body mass index （BMI） was calculated by their stature and weight measured in empty stomach. Their venous blood was taken to detect levels of fasting plasma glucose （FPG）, insulin （INS）, glycosylated hemoglobin （HbA1c）, free triiodothyronine （FT3）, free thyroxine （FT4）, thyroid stimulating hormone （TSH）, triglyceride （TG）, total cholesterol （CHOL）, high-density lipoprotein cholesterol （HDL-C）, and low-density lipoprotein cholesterol （LDL-C）.Results The insulin resistance group had obviously higher levels of BMI, HbA1c, TSH, TG, and LDL-C than the non-insulin resistance group （P〈0.05）; and its FT3 and HDL-C levels were significantly lower than the non-insulin resistance group （P〈0.01）. The differences of gender, age, course of disease, FT4, and CHOL between the two groups had no statistical significance （P〉0.05）. Related analysis showed that HOMA-IR was positively correlated with BMI （r=0.349,P〈0.001）, TSH （r=0.459,P〈0.001）, TG （r=0.191,P〈0.001）, and LDL-C （r=0.114,P=0.037）; and it was negatively correlated with FT3 （r=-0.239,P〈0.001） and HDL-C （r=-0.106,P=0.041）; it had no correlation with HbA1c （r=0.067,P=0.219）. After confounding factor calibration, HOMA-IR was independently correlated with FT3 （r=-0.179,P=0.001） and TSH （r=0.297,P〈0.001）.Conclusion Insulin resistance of T2DM patients is related with thyroid hormones level, and they all influence lipid metabolism. Low level of triiodothyronine （T3） may be the protective mechanism for body’s excessive consumption, and high level of TSH may enhance the progression of insulin resistance of T2DM.