不同血糖水平对甲状腺功能的影响研究

Effects of different blood glucose levels on thyroid function

目的探讨不同血糖水平对甲状腺功能及甲状腺抗体的影响。方法按照排除及纳入标准,选取2018年2月至2019年12月辽宁省人民医院门诊及住院的患者985例。记录入选对象的家族史、疾病史等基本信息,检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺激素(FT4)、促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、血尿酸(UA)及2 h血糖(PPG),记录甲状腺彩超结果。根据HbA1c分成3组:Ⅰ组(HbA1c<6.5%)、Ⅱ组(6.5%≤HbA1c<9%)、Ⅲ组(HbA1c≥9%)。统计不同的HbA1c对甲状腺相关指标的影响及可能的相关因素。结果(1)糖化血红蛋白越高,FT3越低,FT4越高。Ⅲ组TSH高于Ⅱ组。所有入选对象中甲状腺功能异常者共73例,占总体的7.41%,其中发生率最高的为亚临床甲减。Ⅰ、Ⅱ、Ⅲ组间的甲状腺功能异常发生率差异有统计学意义(P=0.000);(2)在线性回归模型中,血清FT3与HbA1c呈负相关(β=-0.150,P=0.006);(3)按照病程长短分为无DM组、<10年组、≥10年组。无DM组FT3高于<10年组和≥10年组(P值分别为0.043和0.018);<10年组TSH低于≥10年组(P=0.037);(4)糖尿病病程是TgAb阳性的独立危险因素(P=0.004);(5)女性血清FT3低于男性(P=0.001)。女性血清TSH高于男性(P=0.011)。结论血糖与甲状腺功能相关。FT3随HbA1c升高而降低。甲状腺功能异常发生率与HbA1c水平、糖尿病有无及其病程相关,HbA1c越高、糖尿病病程越长,甲状腺功能异常发生率越高,其中以亚临床甲减发生率最高。糖尿病病程是TgAb阳性的独立危险因素。

Objective To investigate the effect of different plasma glucose levels on thyroid function.Methods A total of985 outpatients and inpatients were selected,admitted to The People’s Hospital of Liaoning Province from February 2018 to December 2019.The basic information of family history and disease history were recorded.Blood samples were taken to detect fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1 c),serum free triiodothyronine(FT3),serum free thyroid hormone(FT4),thyroid stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),blood uric acid(UA).Two hours later,blood samples were taken to detect postprandial plasma glucose(PPG).Record the results of thyroid ultrasound.The patients were divided into three groups according to HbA1 c:groupⅠ(HbA1 c<6.5%),groupⅡ(6.5%≤HbA1 c<9%),and groupⅢ(HbA1 c≥9%).The influence of different HbA1 c levels on thyroid related indexes and the possible related factors were analyzed.Results(1)The higher the HbA1 c,the lower the FT3 and the higher the FT4.TSH in groupⅢwas higher than that in groupⅡ.There were 73 patients with abnormal thyroid function among all the subjects,accounting for 7.41%of the total,of which the highest prevalence was subclinical hypothyroidism.There was a statistically significant difference in the prevalence of thyroid dysfunction among groupⅠ,ⅡandⅢ(P=0.000);(2)In the linear regression model,there was a negative correlation between serum FT3 and HbA1 c(β=-0.150,P=0.006);(3)All the subjects were divided into DM-free group,<10 years group and≥10 years group according to the course of diabetes.The level of FT3 in DM free group was higher than that in<10 years group and≥10 years group(P=0.043 and 0.018,respectively).The TSH level in the<10 years group was lower than that in the≥10-years group(P=0.037);(4)The course of diabetes was an independent risk factor for positire Tg Ab(P=0.004);(5)The serum FT3 level in women was lower than that in men(P=0.001).The serum TSH level was higher in women than that in men(P=0.011).Conclusion Plasma glucose correlates with thyroid function.The level of serum FT3 decreases with the increase of HbA1 c level.The prevalence of thyroid dysfunction is related to the level of HbA1 c,whether there is diabetes and the course of it.The higher the level of HbA1 c and the longer the course of diabetes,the higher the prevalence of thyroid dysfunction,of which the incidence of subclinical hypothyroidism is the highest.The course of DM is an independent risk factor for positive TgAb.