甲状腺功能正常人群中多种甲状腺参数与糖尿病风险的关系

Association between multiple thyroid parameters and risk of diabetes mellitus in euthyroid population

目的探讨甲状腺功能正常人群的甲状腺功能指标及甲状腺激素敏感指数与糖尿病风险的关系。方法该研究为横断面研究。纳入2017年1月至2018年12月于中国医科大学附属第一医院体检中心进行甲状腺功能检测,显示甲状腺功能正常且基线数据完整的4586名研究对象。收集研究对象的一般临床资料,包括促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、血脂、空腹血糖(FPG)、糖化血红蛋白(HbA1c)等。计算分别反映甲状腺激素中枢和外周敏感性的甲状腺反馈分位数指数(TFQI)和FT_(3)/FT_(4)。采用Spearman相关性分析探究甲状腺参数与FPG和HbA1c的相关性,进一步排除混杂因素的干扰,采用logistic回归模型分析甲状腺参数与糖尿病风险的关联。结果4586名研究对象中,糖尿病组患者546例,患病率为11.9%(546/4586)。FPG水平与FT_(3)(r=0.049,P=0.001)、FT_(4)(r=0.041,P=0.005)和TFQI(r=0.041,P=0.006)呈正相关,与TSH(r=-0.058,P<0.01)呈负相关;HbA1c水平与FT_(4)(r=-0.032,P=0.032)、TSH(r=-0.032,P=0.029)和TFQI(r=-0.032,P=0.032)呈负相关。但校正年龄、性别和体重指数等混杂因素的多因素logistic回归分析表明,糖尿病风险仅与FT_(3)(OR=0.57,95%CI为0.46~0.70)和FT_(3)/FT_(4)(OR=0.78,95%CI为0.70~0.86)水平呈负相关,而与TSH、FT_(4)和TFQI水平无显著关联。结论在甲状腺功能正常的人群中,FT_(3)和反映外周甲状腺激素敏感性的FT_(3)/FT_(4)水平增加与糖尿病风险降低有关。

Objective To evaluate the association between the indicators of thyroid function,sensitivity to thyroid hormones and risk of diabetes in euthyroid population.Methods In this cross-sectional study,4586 euthyroid subjects who had complete baseline data from the health check-up programs in the First Hospital of China Medical University between January 2017 and December 2018 were enrolled.Relevant clinical data including thyrotropin(TSH),free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),blood lipid profiles,fasting plasma glucose(FPG)and glycosylated hemoglobin(HbA1c)were collected.Thyroid feedback quantile based index(TFQI)and FT_(3)/FT_(4) ratio,which reflected the central and peripheral sensitivity to thyroid hormones respectively,were calculated.Spearman correlation analysis between thyroid parameters and indicators of glucose metabolism was performed.To further exclude the interference of cofounding factors,logistic regression analysis was used to evaluate the association between thyroid parameters and the risk of diabetes.Results Among 4586 subjects enrolled in this study,546(11.9%)were diagnosed with diabetes.The level of fasting blood glucose was positively associated with the level of FT_(3)(r=0.049,P=0.001),FT_(4)(r=0.041,P=0.005)and TFQI(r=0.041,P=0.006),while negatively associated with the level of TSH(r=-0.058,P<0.01).HbA1c was negatively associated with FT_(4)(r=-0.032,P=0.032),TSH(r=-0.032,P=0.029)and TFQI(r=-0.032,P=0.032).However,multivariate logistic regression analysis adjusting for confounding factors such as age,sex and BMI,showed that the risk of diabetes was negatively associated with the level of FT_(3)(OR=0.57,95%CI 0.46 to 0.70)and FT_(3)/FT_(4)(OR=0.78,95%CI 0.70 to 0.86),while was not significantly associated with the level of TSH,FT_(4) and TFQI.Conclusion Increased levels of FT_(3) and FT_(3)/FT_(4)(indicators of peripheral sensitivity to thyroid hormones)were associated with lower risk of diabetes in euthyroid population.