甲状腺功能亢进与糖代谢紊乱及胰岛β细胞功能异常、胰岛素抵抗的相关性

Relationship between hyperthyroidism and impaired glucose metabolism, abnormal β-cell function and insulin resistance

目的研究甲状腺功能亢进与糖代谢紊乱、胰岛素β细胞功能异常、胰岛素抵抗的关系。方法选取我院2015年6月至2016年6月收治的48例甲状腺功能亢进患者为甲亢组,及同期在我院行健康体检的40例健康者作为对照组。检测并比较两组受检者的空腹胰岛素(Fins)、餐后2 h胰岛素(2 h INS)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb Alc)、游离甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,并计算胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(ISI)、胰岛β细胞功能(HOMA-IS)。结果甲亢组患者出现糖耐量异常23例,占47.92%,10例糖耐量异常诊断达到糖尿病标准,占20.83%;甲亢组患者的FT3、FT4水平分别为(23.2±6.1)pmol/L、(61.2±20.4)pmol/L,均明显高于对照组,TSH水平为(0.21±0.11)u IU/m L,明显低于对照组,差异均有统计学意义(P<0.05);甲亢组患者的FPG、2 h PG、Hb Alc水平分别为(5.51±0.52)mmol/L、(8.92±1.77)mmol/L、(8.10±1.82)%,均明显高于对照组,差异均有统计学意义(P<0.05);甲亢组患者的2 h INS、HOMA-IR水平分别为(51.3±8.5)m U/L、(1.41±0.33),均较对照组显著升高,HOMA-IS、ISI水平分别为(1.41±0.33)、(-3.90±0.22),均较对照组显著降低,差异均有统计学意义(P<0.05);FT3与HOMA-IR呈正相关(r=0.908,P<0.05),FT4、TSH与HOMA-IR无显著相关性(r=-0.036、-58.755,P>0.05)。结论甲状腺功能亢进患者普遍存在糖代谢紊乱、胰岛β细胞损伤和胰岛素抵抗,且FT3与HOMA-IR有正相关性。

Objective To study the relationship between hyperthyroidism and impaired glucose metabolism,abnormal β-cell function and insulin resistance. Methods A total of 48 patients with hyperthyroidism, who admitted to our hospital from June 2015 to June 2016, were selected as the hyperthyroidism（HT group） group. At the same time, 40 cases of healthy people for health examination in our hospital were selected as the control group. The levels of fasting insulin（Fins）, 2 h postprandial insulin（2 h INS）, fasting plasma glucose（FPG）, 2-hour postprandial blood glucose（2 h PG）,Hb Alc and free triiodothyronine（FT3）, free thyroxine（FT4）, thyroid stimulating hormone（TSH） were detected and compared, and the homeostasis model analysis of insulin resistance index（HOMA-IR）, insulin sensitive index（ISI） and homeostasis model assessment of insulin secretion（HOMA-IS） were calculated. Results In the patients with hyperthyroidism, there were 23 cases of impaired glucose tolerance, accounting for 47.92%, and 10 cases of impaired glucose tolerance were diagnosed as diabetes, accounting for 20.83%. The levels of FT3 and FT4 in the hyperthyroidism group were（23.2±6.1） pmol/L and（61.2±20.4） pmol/L, respectively, which were significantly higher than those in the control group（P〈0.05）; the level of TSH was（0.21±0.11） u IU/m L, which was significantly lower than that of the control group（P〈0.05）. The levels of FPG, 2 h PG and Hb Alc in the hyperthyroidism group were（5.51 ± 0.52） mmol/L,（8.92±1.77） mmol/L,（8.10±1.82）%, respectively, which were significantly higher than those in control group（P〈0.05）.The levels of HINS and HOMA-IR in the hyperthyroidism group were respectively（51.3±8.5） m U/L and（1.41±0.33）,which were significantly higher than those of the control group（P〈0.05）, while the levels of HOMA-IS and ISI were respectively（141±0.33） and（-3.90±0.22）, which were significantly lower than those in the control group（P〈0.05）. FT3 and HOMA-IR were positively correlated（r=0.908,P〈0.05）. FT4 and TSH had no significant correlation with HOMA-IR（r=-0.036,-58.755, P〈0.05）. Conclusion The impaired glucose metabolism, abnormal β-cell function and insulin resistance are common in patients with hyperthyroidism, and FT3 and HOMA-IR are positively correlated.