老年2型糖尿病合并临床甲状腺功能减退及亚临床甲状腺功能减退患者血清apelin水平变化及意义

Change and significance of serum apelin level in elderly patients with type 2 diabetes mellitus complicated with overt hypothyroidism or subclinical hypothyroidism

目的观察老年2型糖尿病(type 2 diabetes mellitus, T2DM)合并临床甲状腺功能减退(overt hypothyroidism, OH)及亚临床甲状腺功能减退(subclinical hypothyroidism, SCH)患者血清apelin水平变化,探讨血清apelin与老年T2DM患者发生OH、SCH的关系。方法老年T2DM患者175例,根据甲状腺功能分为OH组54例、SCH组59例和正常组62例。检测3组血清空腹血糖(fasting plasma glucose, FPG)、糖化血红蛋白(glycosylated hemoglobin A_(1)c, HbA_(1)c)、三酰甘油(triacylglycerol, TG)、总胆固醇(total cholesterol, TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、游离甲状腺素(free thyroxine, FT_(4))、游离三碘甲状腺原氨酸(free triiodothyronine, FT_(3))、促甲状腺激素(thyroid-stimulating hormone, TSH)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody, TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody, TgAb)、apelin水平;Pearson相关法分析老年T2DM患者血清apelin水平与糖脂代谢、甲状腺功能指标的相关性;多重线性回归分析老年T2DM患者血清apelin水平的影响因素;多因素logistic回归分析老年T2DM患者发生OH或SCH的影响因素。结果 OH组、SCH组血清FPG[(9.23±1.95)、(9.10±1.83)mmol/L]、HbA_(1)c[(10.13±1.47)%、(9.39±1.28)%]、TG[(2.71±1.35)、(2.52±1.04)mmol/L]、TC[(7.31±1.92)、(6.09±1.64)mmol/L]、TSH[(62.58±21.35)、(7.29±1.74)u/L]、apelin[(483.19±43.05)、(401.29±40.18)pg/L]水平均高于正常组[FPG(8.11±1.59)mmol/L、HbA_(1)c(8.12±1.03)%、TG(1.83±0.76)mmol/L、TC(4.77±1.18)mmol/L、TSH(1.83±0.62)u/L、apelin(327.91±30.42)pg/L],HDL-C水平[(1.06±0.26)、(1.17±0.21)mmol/L]低于正常组[(1.32±0.23)mmol/L](P<0.05);OH组血清LDL-C、TPOAb、TgAb水平均高于正常组(P<0.05),FT_(4)、FT_(3)水平均低于正常组(P<0.05);SCH组血清LDL-C、FT_(4)、FT_(3)、TPOAb、TgAb水平与正常组比较差异均无统计学意义(P>0.05);OH组血清HbA_(1)c、TC、TSH、TPOAb、TgAb、apelin水平均高于SCH组(P<0.05),HDL-C、FT_(4)、FT_(3)水平均低于SCH组(P<0.05),FPG、TG、LDL-C水平与SCH组比较差异均无统计学意义(P>0.05)。老年T2DM患者血清apelin水平与FPG(r=0.228,P=0.007)、HbA_(1)c(r=0.359,P=0.005)、TG(r=0.491,P=0.001)、TC(r=0.528,P<0.001)、TSH(r=0.662,P<0.001)水平呈正相关,与FT_(4)(r=-0.601,P<0.001)、FT_(3)(r=-0.546,P<0.001)水平呈负相关,与LDL-C、HDL-C、TPOAb、TgAb水平无线性相关(P>0.05)。FPG、TC、TSH正向影响老年T2DM患者血清apelin水平,FT_(4)负向影响老年T2DM患者血清apelin水平(P<0.05)。血清FPG、TC、HDL-C、FT_(4)、FT_(3)、TSH、TPOAb、TgAb、apelin是T2DM患者发生OH或SCH的影响因素(P<0.05)。结论老年T2DM合并OH或SCH患者血清apelin水平明显升高,且与糖脂代谢、甲状腺功能有关,是老年T2DM患者发生OH或SCH的危险因素。

Objective To observe the change of serum apelin level in elderly patients with type 2 diabetes mellitus (T2 DM)complicated with overt hypothyroidism(OH)or subclinical hypothyroidism(SCH),and to explore its relationship with OH and SCH in elderly T2 DM patients.Methods Totally 175 elderly patients with T2 DM were divided into OH group(n=54),SCH group(n=59)and normal thyroid function group(n=62)according to thyroid function,and were detected the levels of serum fasting plasma glucose(FPG),glycosylated hemoglobin A_(1) c(HbA_(1) c),triacylglycerol(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),free thyroxine(FT_(4)),free triiodothyronine(FT_(3)),thyroid-stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb)and apelin.Pearson correlation analysis was used to assess the relationships of serum apelin level with glucose and lipid metabolism as well as thyroid function indicators in elderly T2 DM patients.Multiple linear regression analysis was used to evaluate the influencing factors of serum apelin level in elderly T2 DM patients.Multivariate logistic regression analysis was used to evaluate the influencing factors of OH and SCH in elderly T2 DM patients.Results The levels of FPG((9.23±1.95),(9.10±1.83)mmol/L),HbA_(1) c((10.13±1.47)%,(9.39±1.28)%),TG((2.71±1.35),(2.52±1.04)mmol/L),TC((7.31±1.92),(6.09±1.64)mmol/L),TSH((62.58±21.35),(7.29±1.74)u/L)and apelin((483.19±43.05),(401.29±40.18)pg/L)in OH group and SCH group were higher than those in normal thyroid function group((8.11±1.59)mmol/L,(8.12±1.03)%,(1.83±0.76)mmol/L,(4.77±1.18)mmol/L,(1.83±0.62)u/L,(327.91±30.42)pg/L)(P<0.05),and the level of HDL-C was lower in OH group((1.06±0.26)mmol/L)and SCH group((1.17±0.21)mmol/L)than that in normal thyroid function group((1.32±0.23)mmol/L)(P<0.05).The levels of LDL-C,TPOAb and TgAb were higher in OH group than those in normal thyroid function group(P<0.05),and the levels of FT_(4) and FT_(3) were lower in OH group than those in normal thyroid function group(P<0.05).The levels of LDL-C,FT_(4),FT_(3),TPOAb and TgAb showed no significant differences between SCH group and normal thyroid function group(P>0.05).The serum levels of HbA_(1) c,TC,TSH,TPOAb,TgAb and apelin were higher in OH group than those in SCH group(P<0.05),the levels of HDL-C,FT_(4) and FT_(3) were lower than those in SCH group(P<0.05),and there were no significant differences in the levels of FPG,TG and LDL-C between OH group and SCH group(P>0.05).The serum apelin level was positively correlated with FPG(r=0.228,P=0.007),HbA_(1) c(r=0.359,P=0.005),TG(r=0.491,P=0.001),TC(r=0.528,P<0.001)and TSH(r=0.662,P<0.001),was negatively correlated with FT_(4)(r=-0.601,P<0.001)and FT_(3)(r=-0.546,P<0.001),and was not linearly correlated with the levels of LDL-C,HDL-C,TPOAb and TgAb(P>0.05).FPG,TC and TSH positively affected the serum apelin level,and FT_(4) negatively affected the serum apelin level in elderly T2 DM patients(P<0.05).Serum FPG,TC,HDL-C,FT_(4),FT_(3),TSH,TPOAb,TgAb and apelin were the influencing factors of OH and SCH in T2 DM patients(P<0.05).Conclusion The serum apelin level increases remarkably in elderly T2 DM patients combined with OH or SCH,and is correlated with glucose and lipid metabolism as well as thyroid function.The serum apelin is a risk factor of OH and SCH in elderly T2 DM patients.