老年亚临床甲状腺机能减退症患者促甲状腺素水平和胰岛素抵抗的关系

TSH levels and insulin resistance in a senile population with subclinical hypothyroidism

目的：探讨老年亚临床甲状腺机能减退症（SCH）患者促甲状腺素（TSH）水平与胰岛素抵抗的关系。方法选取老年SCH患者65例，按TSH水平分为两组，即SCH 1组（TSH 4.12～10 mIu／L）和SCH 2组（TSH≥10 mIu／L），并设对照组（TSH＜4.12 mIu／L）42人，分析比较3组血脂、血糖、胰岛素水平，并计算稳态模式下的胰岛素分泌指数（HOMA‐β）及胰岛素抵抗指数（HOMA‐IR）。结果与对照组相比，SCH 1组及SCH 2组TC、LDL‐C均较高（均 P＜0.005）；FINS、HOMA‐β也增高（均 P＜0.05）。SCH 2组FINS水平较SCH 1组高（P＜0.05），SCH 1组HOMA‐IR与对照组比较，差异无统计学意义（P＞0.05），而SCH 2组的HOMA‐IR比对照组高（P＜0.05）。结论老年SCH患者存在血脂紊乱和高胰岛素血症及胰岛素抵抗， TSH水平越高，高胰岛素血症和胰岛素抵抗就越明显。

Objective To explore the association of TSH levels with insulin resistance in a senile population with subclin‐ical hypothyroidism .Methods A total of 65 elderly patients with SCH were divided into two groups by TSH levels as follows ：SCH 1 group （4.12 mIu/L〈 TSH〈10 mIu/L ） and SCH 2 group （TSH≥10 mIu/L） .Another 42 out‐patients （TSH≤4.12 mIu/L） were selected as a control group .Lipids ,glucose ,insulin levels ,homeostasis model assessment‐β（HOMA‐β） ,and ho‐meostasis model assessment insulin resistance （HOMA‐IR） were measured and compared between groups .Results Compared with the control group ,the higher total cholesterol （TC） ,low density lipoprotein‐cholesterol （LDL‐C） levels （P〈0.05） ,and elevated fasting serum insulin （FINS） and HOMA‐βlevels （P〈0.05） were found in SCH 1 and SCH 2 groups .Elevated FINS level was discovered in SCH 2 group compared to SCH 1 group （P〈0.05） .There was no significant difference in HOMA‐IR level between SCH 1 and the control group （P〉0.05） ,but HOMA‐IR level in SCH 2 group was higher than that in the control group （P〈0.05） .Conclusion The phenomenon of lipids abnormality ,hyperinsulinemia and insulin resistance are found in se‐nile SCH patients .Among these patients ,high TSH levels show a consistency with the severity of hyperinsulinemia and insulin resistance .