非糖尿病人群血清促甲状腺激素水平与糖化血红蛋白的相关性研究

Associations between thyrotropin level and glycated hemoglobin A1c in non-diabetic population

目的探讨非糖尿病人群中不同血清促甲状腺激素(TSH)与糖化血红蛋白(HbA1c)的关系。方法2011年5至10月在贵州省贵阳市云岩区,以整群抽样方法抽取居住5年及以上、40岁及以上居民共10140名,最终纳入5819人进行观察。所有调查对象均进行详细的流行病学问卷调查,收集基本资料,测量体重指数(BMI)、腰围、血压、血糖、血脂、胰岛素、HbA1c及TSH。将人群分为TSH正常组(0.55 mU/L≤TSH<4.78 mU/L)和TSH升高组(TSH≥4.78 mU/L)。以HbA1c>6.0%为HbA1c升高,HbA1c≤6.0%为HbA1c正常。正态分布的计量资料2组间比较采用t检验,偏态分布的计量资料组间比较采用非参数检验。各因素与HbA1c的相关性采用logistic回归分析。结果TSH正常组4632名,TSH升高组1187名。与TSH正常组相比,TSH升高组HbA1c值较低,差异有统计学意义(P<0.05);TSH升高组体质指数(BMI)、胰岛素、稳态模型评估胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及总胆固醇(TC)较高,差异均有统计学意义(P<0.05)。以HbA1c为因变量,在校正年龄、收缩压、舒张压、BMI、腰围、空腹血糖、糖耐量试验2 h血糖、胰岛素、HOMA-IR、TG、HDL-C、LDL-C等相关指标后,进行logistic回归分析结果显示,与TSH正常组相比,TSH升高组为影响HbA1c的独立因素,TSH与HbA1c呈负相关(OR=0.845,P=0.024,95%可信区间为0.730~0.978)。进一步性别分层后,男性人群TSH为影响HbA1c的独立因素,二者呈负相关(OR=0.672,P=0.034,95%可信区间为0.466~0.970),而女性人群TSH与HbA1c无明显相关性。结论在非糖尿病人群中,TSH升高可能降低HbA1c水平,男性非糖尿病人群血清TSH与HbA1c呈负相关,女性非糖尿病人群血清TSH与HbA1c无明显相关。

Objective To investigate the relationship between serum thyrotropin(TSH)and glycated hemoglobin A1c(HbA1c)in non-diabetic patients.Methods From May to October 2011,10140 permanent residents aged over 40 years old were sampled by cluster sampling method in yunyan district of guiyang city,and 5819 residents were eventually included.All the subjects were investigated by detailed epidemiological questionnaire,and the basic data were collected to measure body mass index(BMI),waist circumference,blood pressure,blood glucose,blood lipid,insulin,glycosylated hemoglobin and thyrotropin.Non parameter test t test,and logistic regression analysis were used.Results According to TSH level,the population was divided into the normal TSH group and the elevated TSH group.Compared with the normal TSH group,the HbA1c value of the elevated TSH group was lower(P<0.05),while the BMI,fasting insulin(FINS),homesostasis model assessment of insulin resistance(HOMA-IR),triglyceride(TG),low-density lipoprotein-cholesterol(LDL-C)and total cholesterol were higher,with statistically significant differences(P<0.05).After adjusting for age,systolic pressure,diastolic pressure,BMI,waist circumference,FPG,OGTT 2 h blood glucose,FINS,HOMA-IR,TG,HbA1c,LDL-C,logistic regression analysis results showed that compared with the normal TSH group,the elevated TSH group was the factor affecting HbA1c.TSH was negatively correlated with HbA1c(OR=0.845,P=0.024,95%CI=0.730 to 0.978).After further gender stratification,the negative correlation between TSH and HbA1c was found only in males(OR=0.672,P=0.034,95%CI=0.466 to 0.970),but not in females.Conclusion In non-diabetic population,increased TSH may reduce the level of HbA1c.Serum TSH in male non-diabetic population is negatively correlated with HbA1c,while serum TSH in female non-diabetic population is not significantly correlated with HbA1c.