甲状腺功能正常2型糖尿病患者促甲状腺激素与血清同型半胱氨酸的相关性及评估价值

Relationship and assessment value between serum homocysteine and thyroid stimulating hormone in type 2 diabetic patients with normal thyroid function

目的探讨甲状腺功能正常2型糖尿病患者促甲状腺激素与血清同型半胱氨酸的相关性及评估价值。方法选取2017年1月—2019年4月合肥市第二人民医院住院的124例2型糖尿病患者作为研究组,按促甲状腺激素水平分为研究1组(促甲状腺激素<0.49μIU/ml)22例,研究2组(促甲状腺激素0.49~4.91μIU/ml)82例,研究3组(促甲状腺激素>4.91μIU/ml)20例。并选择同期该院体检者50例为对照组,检测各组受试者外周血促甲状腺激素、血清同型半胱氨酸、血脂、血糖等临床指标,并分析同型半胱氨酸与促甲状腺激素、血脂和血糖的相关性。结果4组的同型半胱氨酸、血脂和血糖水平比较,差异有统计学意义(P<0.05),与对照组比较,3个研究组患者血清同型半胱氨酸、高密度脂蛋白、低密度脂蛋白、总胆固醇、甘油三酯、糖化血红蛋白和血糖水平均较高。4组的血管并发症发生率比较,差异有统计学意义(P<0.05),进一步两两比较,经χ~2分割法,3个研究组患者血管并发症较对照组均偏高(P<0.007)。同型半胱氨酸水平与促甲状腺激素、低密度脂蛋白、甘油三酯、总胆固醇、糖化血红蛋白、收缩压和年龄呈正相关(P<0.05),与高密度脂蛋白、空腹血糖和病程无相关(P>0.05)。结论甲状腺功能正常2型糖尿病患者血清同型半胱氨酸与其自身促甲状腺激素水平有关,同型半胱氨酸的升高和异常的促甲状腺激素水平可能会造成机体代谢紊乱,加快患者病情进展,筛查甲状腺功能正常2型糖尿病患者的血清同型半胱氨酸水平及甲状腺功能具有重要意义。

Objective To investigate the relationship and assessment value between serum thyroid stimulating hormone and homocysteine in patients with type 2 diabetes mellitus with normal thyroid function.Methods From January 2017 to April 2019,124 type 2 diabetes patients who were hospitalized were selected as the study group.The study group was divided into 3 groups according to the level of thyrotropin:study group 1(thyroid stimulating hormone<0.49μIU/ml)22 cases,study group 2(thyroid stimulating hormone 0.49 to 4.91μIU/ml)82 cases,and study group 3(thyroid stimulating hormone>4.91μIU/ml).Fifty healthy people who came to our hospital at the same period were selected as the control group.The peripheral blood thyroid stimulating hormone,serum homocysteine,blood lipids,blood glucose and other clinical indicators were tested in each group.The correlations between homocysteine and thyroid stimulating hormone,blood lipids and blood glucose were analyzed.Results The homocysteine,blood lipid and blood glucose levels of 4 groups were analyzed by ANOVA,and the difference was statistically significant(P<0.05).Compared with the control group,the serum homocysteine,high-density lipoprotein,low-density lipoprotein,total cholesterol,triglycerides,glycated hemoglobin,and blood glucose levels had relatively increased(P<0.05),and showed a trend of thyroid stimulating hormone dependent manner.The incidence of vascular complications in the 4 groups was statistically significant by Chi-square test(P<0.05).Compared with the control group,the vascular complications rates of 3 study groups had increased,and showed a trend of thyroid stimulating hormone dependent manner.Homocysteine level was positively correlated with thyroid stimulating hormone,low density lipoprotein,triglyceride,total cholesterol,glycated hemoglobin,systolic blood pressure,and age(P<0.05),and was not associated with high density lipoprotein,fasting blood glucose and course of disease(P>0.05).Conclusion The serum homocysteine in type 2 diabetes patients with normal thyroid function is closely related to thyroid stimulating hormone levels.The increased homocysteine and abnormal thyroid stimulating hormone levels may cause metabolic disorders and accelerate the progress of the patient’s condition.Screening serum homocysteine and thyroid function in type 2 diabetes patients with normal thyroid function is of great significance.