男性2型糖尿病合并良性甲状腺结节患者的内分泌激素特征

Endocrine Hormone Profile in Male Type 2 Diabetes Mellitus Patients with Benign Thyroid Nodules

目的探讨男性2型糖尿病(T2DM)合并良性甲状腺结节患者的内分泌激素特征。方法选取2015年1月至2018年1月于我院内分泌科就诊的269例男性T2DM合并良性甲状腺结节患者(结节组),依据甲状腺结节大小分为小结节亚组(直径<1cm,101例)、中结节亚组(直径1~2cm,89例)和大结节亚组(直径>2cm,79例);另外选择同期就诊的178例男性T2DM无甲状腺结节患者作为对照组。对2组患者的基线资料[年龄、体质量指数(BMI)、空腹血糖(FPG)、餐后2h血糖(PBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(INS)、稳态模型评估-胰岛素抵抗指数(HOMA-IR)、血压、血脂]、甲状腺激素[血清游离甲状腺素(FT4)、血清游离三碘甲腺原氨酸(FT3)]、性激素[总睾酮(TT)、雌二醇(E2)、孕酮(P)、催乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH)]、肾上腺激素[皮质醇(Cor)、促肾上腺皮质激素(ACTH)]等进行比较。对结节大小与激素水平的关系进行相关性分析和多因素logistic回归分析。结果结节组INS、HOMA-IR、LH、TSH水平均高于对照组(P<0.05)。亚组分析显示,大结节亚组INS、HOMA-IR、LH、TSH水平高于小结节亚组(P<0.05)。结节直径与INS、HOMA-IR、LH、TSH正相关(均P<0.05)。多因素logistic回归分析显示INS、HOMA-IR、LH、TSH是甲状腺结节发病的独立危险因素(均P<0.05)。结论内分泌失衡与男性T2DM患者良性甲状腺结节发病关系密切;INS、HOMA-IR、LH和TSH是甲状腺结节发病的独立危险因素。

Objective To investigate the endocrine hormone profile of male patients with type 2 diabetes mellitus(T2DM)complicated with benign thyroid nodules(BTN).Methods A total of 269 male T2DM patients with BTN that were admitted to our hospital between January 2015 and January 2018 were selected for study.These patients constituted the nodule group,which was further divided into the small,medium,and large nodule subgroups.In contrast,the control group included 178 male patients with T2DM,but without thyroid nodules.We compared patients’baseline data as well as thyroid,sex,and adrenal hormone levels between groups.Correlation analysis and multivariate logistic regression analysis were used to evaluate the specific relationship between nodule size and hormone levels.Results Subgroup analysis showed that the levels of insulin resistance(by homeostasis model assessment,HOMA-IR),insulin(INS),luteinizing hormone(LH),and thyroid-stimulating hormone(TSH)in the patients from the large nodule subgroup were higher than in those from the small nodule subgroup(P<0.05).Additionally,correlation analysis demonstrated that the nodule diameter was positively correlated with HOMA-IR,INS,LH,and TSH levels(P<0.05),which were all considered independent risk factors of thyroid nodules by multivariate logistic regression analysis.Conclusion Endocrine imbalance is closely related to BTN occurrence in male patients with T2DM.In these patients,it is anticipated that the levels of several hormones,besides INS,HOMA-IR,LH,and TSH,will increase with larger BTN.