肥胖者高TSH水平诱导胰岛β细胞功能与胰岛素抵抗的关系

The relationship between Insulin Resistance and Isletβ-cell Function induced by high Level of TSH in obese Subjects

目的 探究肥胖者促甲状腺激素(TSH)水平升高对胰岛β细胞功能与胰岛素抵抗的影响。方法 选取2017年5月至2019年5月于临沂市中心医院内分泌门诊收治的82例肥胖患者作为研究对象,以血清TSH=2.5 mU/L为界分为单纯性肥胖组和高TSH肥胖组。高TSH肥胖组42例,单纯性肥胖组40例。测定两组研究对象总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C);空腹血糖(FPG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA1c);促甲状腺素、空腹胰岛素(FINS)水平,计算胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR);甲功三项:游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、分析TSH与HOMA-β、HOMAIR的相关性。结果 高TSH肥胖组TC、TG、LDL-C高于单纯性肥胖组,HDL-C低于单纯性肥胖组,差异具有统计学意义(P <0.05);高TSH肥胖组HOMA-β水平低于单纯性肥胖组,FINS、C肽、HOMA-IR水平高于单纯性肥胖组,差异均具有统计学意义(P <0.05);高TSH肥胖组TSH高于单纯性肥胖组,FT3、FT4低于单纯性肥胖组,差异具有统计学意义(P <0.05);Pearson相关性分析显示,肥胖者血清TSH水平与HOMA-β呈负相关,差异有统计学意义(r=-0.542,P <0.05),与HOMA-IR呈正相关,差异有统计学意义(r=0.689,P <0.05)。结论 肥胖者TSH水平升高能影响胰岛β细胞功能、加重胰岛素抵抗,临床需加强对肥胖者的甲状腺功能筛查,从而降低代谢并发症的发生。

Objective To investigate the effect of high level of elevated thyroid stimulating hormone(TSH)on insulin resistance and isletβ-cell function in obese people.Methods A total of 82 obese patients who were admitted to the endocrine clinic of Linyi Central Hospital from May 2017 to May 2019 were selected as the study subjects.With serum TSH=2.5 mU/L as the boundary,they were divided into simple obesity group and high TSH obesity group.There were 42 cases in obesity group with high TSH and 40 cases in simple obesity group.Total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C),fasting plasma glucose(FPG),postprandial 2h plasma glucose(2h PG)and glycated hemoglobin(HbA1c),fasting insulin(FINS)were measured,calculate isletsβcell function index(HOMA-β),insulin resistance index(HOMA-IR),three items of thyroid function:free triiodothyronine(FT3),free thyroxine(FT4)were measured in the two groups;The correlation of TSH with HOMA-βand HOMA-IR was analyzed.Results TC,TG,LDL-C in obesity group with high TSH were higher than those in simple obesity group,and HDL-C were lower than those in simple obesity group,the difference was statistically significant(P<0.05);HOMA-βin obesity group with high TSH was lower than those in simple obesity group,the levels of FINS,C-peptide and HOMA-IR were significantly higher than those in simple obesity group(P<0.05);TSH in obesity group with high TSH was higher than that in simple obesity group,and FT3 and FT4 were lower than those in simple obesity group,with significant difference(P<0.05);Pearson correlation analysis showed that there was a negative correlation between serum TSH level and serum HOMA-βlevel in obese patients,the difference was statistically significant(r=-0.542,P<0.05),and there was a positive correlation with HOMA-IR,the difference was statistically significant(r=0.689,P<0.05).Conclusion The increase of TSH level in obese patients can affect the function of isletβcells and aggravate insulin resistance.It is necessary to strengthen the thyroid function screening in obese patients in order to reduce the occurrence of metabolic complications.