2型糖尿病甲状腺结节影响因素与甲状腺球蛋白抗体和甲状腺过氧化物酶抗体的相关性分析

TGAb and TPOAb in correlation with the influencing factors on type 2 diabetic thyroid nodules

【目的】探讨影响2型糖尿病甲状腺结节患者的相关因素,并分析甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)和甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)在检测中的作用。【方法】按照甲状腺结节数的不同,分成无结节组、单发结节组和多发结节组,分别检测3组患者血糖、血脂、胰岛功能等指标,并分析TGAb和TPOAb与血糖、血脂、胰岛功能的相关性。【结果】与无结节组相比,单发结节组和多发结节组患者的糖化血红蛋白(haemoglobin A1C,Hb A1c)、空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2 hour plasma glucose,2-PG)、餐后2 h空腹胰岛素(2 hour post-meal insulin,2-INS)均显著增加(P<0.05);甲状腺功能分析显示,单发结节组与多发结节组的TGAb、TPOAb均比无结节组显著增高(P<0.05),而与单发结节组相比,多发结节组的TGAb、TPOAb比单发结节组显著增高(P<0.05)。相关性分析显示,结节患者TGAb、TPOAb分别与Hb A1c、2-PG、2-INS均呈正相关(r>0.1,P<0.05),而在多发结节组患者中,TPOAb与Hb A1c呈现显著正相关(r>0.1,P<0.05),与FINS、2-INS呈现极显著正相关(r>0.1,P<0.01),与单发结节组不同。经超声检测,单发结节组和多发结节组患者结节的大小分布无明显差异(χ2=1.258,P=0.262),同时单发结节组和多发结节组患者结节的回声的分布也无明显差异(χ2=1.009,P=0.604)。单发结节和多发结节患者应该重点关注低回声结节接的情况。【结论】2型糖尿病患者与甲状腺功能紊乱有着密切的联系,TGAb、TPOAb可以作为甲状腺结节检测的指标应用于临床。

[ Objective ] To explore the influencing factors on type 2 diabetic thyroid nodules and assess the roles of TGAb and TPOAb in the detection. [ Methods ] According to the number of thyroid nodules, the patients were divided into 3 groups： no thyroid-nodule group （n=160）, Solitary thyroid-nodule group （n=78） and multiple thyroid-nodule group （n=110）. Blood glucose level, blood lipid level and pancreatic-islet function were detected and analyzed if correlated with TGAb and TPOAb. [ Results]HbAlc%, FBG, 2-PG and 2-INS were significantly higher in solitary thyroid-nodule group and multiple thyroid-nodule group than those in no thyroid-nodule group （P〈 0.05）. The analysis of thyroid function showed that TGAb and TPOAb were significantly higher in solitary thyroid-nodule group and multiple thyroid-nodule group than those in no thyroid-nodule group （P〈0.05）. Compared with those in solitary thyroid-nodule group, TGAb and TPOAb increased significantly in muhiple thyroid-nodule group. TGAb and TPOAb were positively correlated with HbAlc%, 2-PG, 2-INS respectively in solitary thyroid-nodule group and muhiplc thyroid-nodule group （r〉0.1, P〈0.05）. Moreover, TPOAb was significantly positively correlated with FINS and 2-INS in multiple thyroid-nodule group（r〉0.1, P〈0.01）. Ultrasonic testing showed that there was no significant difference between solitary thyroid-nodule group and multiple thyroid-nodule group in size （X2 = 1.258, P= 0.262） and echo （X2 = 1.009, P=0.604）. Hypoechoic nodules should be focused on. [Conclusion] Type 2 diabetes mellitus is tightly associated with thyroid dysfunction. TGAb and TPOAb could serve as effective indicators to detect thyroid nodules in clinic.