不同体重指数及腰围2型糖尿病患者甲状腺功能的变化探讨

Changes of thyroid function of type 2 diabetic patients with different body mass index and waist circumference

目的探讨不同体重指数(BMI)及腰围(WC)2型糖尿病(T2DM)患者促甲状腺激素(TSH)和甲状腺激素(TH)水平的变化及肥胖对TSH、TH的影响。方法收集住院T2DM患者275例,根据BMI不同将其分为正常组(18.5kg/m^2≤BMI<24kg/m^2,88例)、超重组(24kg/m^2≤BMI<28kg/m^2,90例)和肥胖组(BMI≥28kg/m2,97例),比较3组患者的血脂水平及甲状腺功能。再根据性别和WC不同将其分为M1组(男性WC<85cm)、M2组(男性WC≥85cm)、F1组(女性WC<80cm)、F2组(女性WC≥80cm),比较各组间上述指标。相关性分析采用Spearman相关分析,影响因素分析采用多元线性逐步回归分析。结果与正常组比较,超重组及肥胖组患者的TSH水平明显增加(P<0.05)。F2组TSH水平明显高于F1组和M2组,游离甲状腺素(FT4)水平低于M2组(P<0.05)。相关性分析结果显示,T2DM患者BMI与TSH呈正相关(r=0.25,P<0.05),TC与游离三碘甲腺原氨酸(FT3)呈负相关(r=-0.39,P<0.05),BMI、WC与FT4(r=-0.31,r=-0.29,P<0.05)呈负相关。多元线性逐步回归分析结果显示,BMI是TSH的独立相关因素,WC是FT4的独立相关因素(P<0.05)。结论肥胖T2DM患者TSH水平升高,FT4下降,女性较男性腹型肥胖者变化更加明显。

Objective To explore the changes of thyroid stimulating hormone(TSH)and thyroid hormone(TH)levels in type 2 diabetic patients with different body mass index(BMI)and waist circumference(WC)and the influence of obesity on TSH and TH.Methods A total of 275 hospitalized patients with type 2 diabetes were collected.They were divided into the normal group(18.5kg/m^2≤BMI<24kg/m^2,88 cases),overweight group(24kg/m^2≤BMI<28kg/m2,90 cases)and obesity group(BMI≥28kg/m^2,97cases)according to BMI.The blood lipid levels and thyroid function among these three groups were compared.Then,them were divided into M1 group(male WC<85cm),M2 group(male WC≥85cm),F1 group(female WC<80cm),F2 group(female WC≥80cm)according to gender and WC.Make a comparison among the above indexes among these groups.Spearman correlation analysis was used to analyze correlation and multiple linear stepwise regression was used for influence factor analysis.Results Compared with the normal group,TSH levels in the overweight group and obesity group were significantly increased(P<0.05).TSH level in F2 group was obviously higher than those in F1 group and M2 group,and free thyroxine(FT4)level was lower than that in M2 group(P<0.05).The results of correlation analysis showed that BMI of type 2 diabetic patients was positively correlated with TSH(r=0.25,P<0.05),TC was negatively related with FT3(r=-0.39,P<0.05),and BMI and WC were negatively related with FT4(r=-0.31,r=-0.29,P<0.05).The results of multiple linear stepwise regression showed that BMI was an independent correlative factor for TSH,and WC was an independent correlative factor for FT4(P<0.05).Conclusion The TSH level of obese patients with type 2 diabetes is increased,and FT4 is decreased,which are more obvious in female patients with abdominal obesity than those in males.