女性2型糖尿病患者高三酰甘油腰围表型与甲状腺激素的相关性研究

Correlation between Hypertriglyceridemic Waist Phenotype and Thyroid Hormone in Women with Type 2 Diabetes Mellitus

背景高三酰甘油腰围表型(HTGW)是测量内脏肥胖的新型指标,与心血管、糖尿病等疾病密切相关,但目前国内外有关HTGW与甲状腺激素关系的研究较少。目的探究女性2型糖尿病患者HTGW与甲状腺激素的相关性。方法选取2017年5月—2019年5月于西南医科大学附属医院就诊的符合研究标准的女性2型糖尿病患者308例,以腰围<80 cm及三酰甘油(TG)<1.7 mmol/L为参考范围,将患者分为A组(腰围及TG均在参考范围,n=55)、B组(腰围在参考范围、TG不在参考范围,n=47)、C组(腰围不在参考范围、TG在参考范围,n=87)、D组(腰围及TG均不在参考范围,n=119);同时根据内脏脂肪面积,将患者分为Ⅰ组(内脏脂肪面积<100 cm^2,n=236)、Ⅱ组(内脏脂肪面积≥100 cm^2,n=72)。采用Spearman秩相关分析观察女性2型糖尿病患者甲状腺激素与腰围、TG、HTGW的相关性;采用多因素Logistic回归分析探究女性2型糖尿病患者发生HTGW的影响因素。结果女性2型糖尿病患者腰围83.0(13.0)cm,TG 1.80(1.32)mmol/L,促甲状腺激素(TSH)2.09(2.07)mmol/L,游离甲状腺素(FT4)1.23(0.27)mmol/L,游离三碘甲状腺原氨酸(FT3)2.37(0.48)mmol/L;HTGW患者119例,非HTGW患者189例。女性2型糖尿病患者TSH与腰围(rs=0.13,P=0.03)、HTGW(rs=0.14,P=0.01)呈正相关;FT4与HTGW(rs=-0.17,P=0.02)呈负相关;FT3与腰围(rs=0.13,P=0.02)呈正相关。多因素Logistic回归分析结果显示,腰围〔OR=1.236,95%CI(1.139,1.343)〕、TG〔OR=2.501,95%CI(1.365,3.082)〕、低密度脂蛋白(LDL)〔OR=3.045,95%CI(1.342,6.906)〕、FT4〔OR=0.226,95%CI(0.066,0.782)〕是女性2型糖尿病患者发生HTGW的影响因素(P<0.05)。结论女性2型糖尿病患者HTGW与FT4呈负相关,与TSH呈正相关,且FT4是女性2型糖尿病患者发生HTGW的影响因素。

Background Hypertriglyceridemic waist(HTGW)phenotype is a new indicator for the measurement of visceral obesity,which is closely related to cardiovascular and diabetes diseases.However,there are few studies on the relationship between HTGW phenotype and thyroid hormone.Objective To explore the correlation between HTGW phenotype and thyroid hormone in women with type 2 diabetes(T2DM).Methods 308 eligible women with T2DM from the Affiliated Hospital of Southwest Medical University were enrolled during May 2017 to May 2019.They were divided into 4 groups by the normal reference range of waistline(<80 cm)and of triacylglycerol(<1.7 mmol/L):group A(normal waistline and triacylglycerol,n=55),group B(normal waistline but elevated triacylglycerol,n=47),group C(elevated waistline but normal triacylglycerol,n=87),and group D(elevated waistline and triacylglycerol,n=119),and were stratified into 2 groups by the visceral fat area:groupⅠ(visceral fat area<100 cm^2,n=236)and groupⅡ(visceral fat area≥100 cm^2,n=72).Spearman rank correlation analysis was used to estimate the correlation of thyroid hormone with waist circumference,triacylglycerol and HTGW.Multivariate Logistic regression analysis was used to explore the influencing factors of HTGW in women with T2DM.Results The median waist circumference,triacylglycerol,thyroid stimulating hormone(TSH),free thyroxine(FT4)and free triiodothyronine(FT3)for the participants were 83.0(13.0)cm,1.80(1.32)mmol/L,2.09(2.07)mmol/L,1.23(0.27)mmol/L and 2.37(0.48)mmol/L,respectively.There were 119 HTGW patients and 189 non-HTGW patients.TSH was positively correlated with waist circumference(rs=0.13,P=0.03)and HTGW(rs=0.14,P=0.01).FT4 was negatively correlated with HTGW(rs=-0.17,P=0.02).FT3 was positively correlated with waist circumference(rs=0.13,P=0.02).Multivariate Logistic regression analysis showed that waist circumference〔OR=1.236,95%CI(1.139,1.343)〕,triacylglycerol〔OR=2.501,95%CI(1.365,3.082)〕,low-density lipoprotein〔OR=3.045,95%CI(1.342,6.906)〕,and FT4〔OR=0.226,95%CI(0.066,0.782)〕were associated with HTGW in women with T2DM(P<0.05).Conclusion In women with T2DM,HTGW was negatively correlated with FT4 but positively correlated with TSH.FT4 was an influencing factor for HTGW in women with T2DM.