2型糖尿病患者高甘油三酯血症-腰围表型与甲状腺功能异常的关系

Association of hypertriglyceridaemic-waist phenotype with thyroid dysfunction in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者高甘油三酯血症．腰围表型（HTwc）与甲状腺功能的关系。方法选取2型糖尿病患者808例，以血甘油三酯≥1.7mmol／L、腰围男性≥85cm或女性≥80cm为切点，分为4组：正常组（n=162）、单纯高甘油三酯组（n=112）、单纯腹型肥胖组（n=262）、HTWC组（n=272）。测量所有患者身高、体重、腰围、血压；检测血糖、血脂、促甲状腺激素、游离T3、游离T4、甲状腺过氧化物酶抗体水平，计算体重指数以及稳态模型评估-胰岛素抵抗指数（HOMA-IR）。结果HTWC组体重指数、收缩压、腰围、HOMA．IR、促甲状腺激素、甲状腺过氧化物酶抗体均高于其他3组（F=5．537～53．038，P均〈0．05），而高密度脂蛋白．胆固醇、游离T4显著低于其他3组（F=8．561，4．399，P均〈0．05），且HTWC组亚临床甲状腺功能减退症和甲状腺抗体阳性发生率较其余3组明显升高（x2=4．348，4．774，P均〈0．05）。L0加廊回归分析显示HTWC是2型糖尿病发生亚临床甲状腺功能减退症的危险因素（优势比=1．461，95％CI：1．073，1．990，P=0．016）。结论在2型糖尿病患者中，HTWC与甲状腺功能异常存在相关性，并可增加亚临床甲状腺功能减退症的患病风险。

Objective To investigate the association of hypertriglyceridaemic-waist （HTWC） phenotype with thyroid function in patients with type 2 diabetes mellitus. Methods Based on the cutoff point of plasma triglycerides concentration （ ≥ 1.7 mmol/L） and waist circumference （ ≥ 85 cm in men or ≥ 80 cm in women ）, 808 patients with type 2 diabetes mellitus were divided into four groups：normal group （n= 162）, hypertriglyceridemia group （u= 112）, abdominal obesity group （n=262） and HTWC group （n=272）. Height, weight, waist circumference,blood pressure were measured. Levels of blood glucose,blood lipids,thyroid stimulating hormone, free T3, free T4 and thyroid peroxidase antibody were detected. Body mass index （ BMI ）, homeostasis model assessment-insulin resistance （HOMA-IR） were calculated. Results BMI, systolic blood pressure ,waist circumference, HOMA-IR, thyroid stimulating hormone and thyroid peroxidase antibody in HTWC group were significantly higher than those in other three groups （ F =5.537-53.038, all P 〈 0.05 ） ,while high density lipoprotein-cholesterol and free Ta were lower than those in other three groups（ F = 8.561,4.399, all P〈0.05 ）. Compared with other three groups, the incidence of subclinical hypothyroidism and positive thyroid autoantibody were significant increased in HTWC group （X2=4.348, 4.774, all P〈0.05 ）. Logistic regression analysis revealed that HTWC was a risk factor of subclinical hypothyroidism in type 2 diabetes mellitus （odd ratio=l.461,95%CI：1.073-1.990,P =0.016）. Conclusion HTWC associates with thyroid dysfunction, and may increase the risk of subclinical hypothyroidism in type 2 diabetes mellitus.