甲状腺功能亢进与胰岛素抵抗、糖代谢紊乱、胰岛β细胞功能异常的相关性

The Relationship between Hyperthyroidism and Insulin Resistance,Glucose Metabolism Disorders,and Pancreaticβ-cell Dysfunction

目的分析甲状腺功能亢进(甲亢)与胰岛素抵抗、糖代谢紊乱、胰岛β细胞功能异常的相关性。方法便利选取2020年4月—2021年4月69例甲亢患者为研究对象期间该院收治的患者,将其作为研究组。选择同期于该院进行体检的69名健康受检者,将其作为对照组。两组患者均进行甲状腺、胰岛素抵抗、糖代谢、胰岛β细胞功能相关指标检测。观察研究组患者糖耐量异常与2型糖尿病的发生率,比较两组甲状腺功能指标[促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)]、血糖指标[糖化血红蛋白(HbA1c)、餐后2 h血糖(2 hPG)、空腹血糖(FPG)]、胰岛功能指标[餐后2 h胰岛素(2 hINS)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞指数(HOMA-β)],并分析TSH、FT3、FT4与HbA1c、HOMA-β、HOMA-IR的相关性。结果研究组有38例(55.07%)发生糖耐量异常,19例(27.54%)达到糖尿病标准。研究组TSH(0.22±0.12)μIU/mL较对照组(2.50±0.35)μIU/mL低,差异有统计学意义(t=51.187,P<0.001),FT3、FT4较对照组高,差异有统计学意义(t=18.908、14.221,P<0.01)。研究组2 hPG、FPG、HbA1c较对照组高,差异有统计学意义(t=11.095、8.629、15.244,P<0.001)。研究组2 hINS、HOMA-IR较对照组高,差异有统计学意义(t=16.458、15.867,P<0.001),HOMA-β较对照组低,差异有统计学意义(t=4.514,P<0.001)。研究组FT3与HbA1c与HOMA-IR呈正相关(r=0.458、0.588,P=0.015、0.025),与HOMA-β呈负相关(r=-2.050,P=0.032);FT4与HbA1c与HOMA-IR呈正相关(r=0.252、0.352,P=0.012、0.010),与HOMA-β呈负相关(r=-3.523,P=0.020);TSH与HbA1c与HOMA-IR呈负相关(r=-2.523、-2.032,P=0.028、0.030),与HOMA-β呈正相关(r=0.523,P=0.023)。结论甲亢能够导致胰岛素抵抗、糖代谢紊乱、胰岛β细胞功能异常,临床应给予足够的重视。

Objective To analyze the correlation between hyperthyroidism(hyperthyroidism)and insulin resistance,glucose metabolism disorders,and pancreaticβ-cell dysfunction.Methods Conveniently selected all 69 patients with hyperthyroidism who admitted to the hospital from April 2020 to April 2021 as objects of the study,and they were taken as the study group.69 healthy subjects who underwent physical examination in this hospital during the same period were selected as the control group.Both groups of patients were tested for related indicators of thyroid,insulin resistance,glucose metabolism,and pancreaticβ-cell function.Observe the incidence of impaired glucose tolerance and type 2 diabetes in the study group,compare the two groups of thyroid function indicators[thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4)],blood glucose Indexes[glycated hemoglobin(HbA1c),2h postprandial blood glucose(2 hPG),fasting blood glucose(FPG)],islet function index[2 h postprandial insulin(2 hINS),fasting insulin(FINS),insulin resistance index(HOMA-IR),Isletβcell index(HOMA-β)],and analyze the correlation between TSH,FT3,FT4 and HbA1c,HOMA-β,HOMA-IR.Results In the study group,38 cases(55.07%)developed impaired glucose tolerance,and 19 cases(27.54%)reached the diabetes standard.TSH(0.22±0.12)μIU/mL in the study group was lower than that in the control group(2.50±0.35)μIU/mL,the difference was statistically significant(t=51.187,P<0.01),and FT3 and FT4 were higher than those in the control group,the difference was statistically significant(t=18.908,14.221,P<0.001).The 2 hPG,FPG and HbA1c of the study group were higher than those of the control group,the difference was statistically significant(t=11.095,8.629,15.244,P<0.001).The 2 hINS and HOMA-IR of the study group were higher than those of the control group,the difference was statistically significant(t=16.458,15.867,P<0.001),and HOMA-βwas lower than that of the control group,the difference was statistically significant(t=4.514,P<0.001).Research group FT3 and HbA1c are positively correlated with HOMA-IR(r=0.458,0.588,P=0.015,0.025),and negatively correlated with HOMA-β(r=-2.050,P=0.032);FT4 and HbA1c were positively correlated with HOMA-IR(r=0.252,0.352,P=0.012,0.010),and negatively correlated with HOMA-β(r=-3.523,P=0.020);TSH and HbA1c are negatively correlated with HOMA-IR(r=-2.523,-2.032,P=0.028,0.030),positively correlated with HOMA-β(r=0.523,P=0.023).Conclusion Hyperthyroidism can lead to insulin resistance,glucose metabolism disorders,and pancreaticβ-cell dysfunction,and adequate attention should be paid clinically.