2型糖尿病患者血清胰岛素样生长因子1、促甲状腺激素及胰岛素抵抗程度与甲状腺结节影像报告和数据系统分级的相关性

Correlation between serum insulin-like growth factor 1,thyroid stimulating hormone,degree of insulin resistance and thyroid nodule imaging reporting and data system in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者血清胰岛素样生长因子1(IGF-1)、促甲状腺激素(TSH)及胰岛素抵抗程度与甲状腺结节影像报告和数据系统(TI-RADS)分级的相关性。方法回顾性分析2020年2月至2021年11月昆山市中西医结合医院120例T2DM患者的临床资料。其中,无甲状腺结节56例(非甲状腺结节组),即TI-RADS 1级;有甲状腺结节64例(甲状腺结节组),包括TI-RADS 2级7例,TI-RADS 3级12例,TI-RADS 4级20例,TI-RADS 5级25例。采用全自动生化分析仪检测IGF-1和TSH水平,并计算稳态模型评估法胰岛素抵抗指数(HOMA-IR)。采用Spearman法进行相关性分析;多因素Logistic回归分析影响T2DM合并甲状腺结节患者TI-RADS分级的独立危险因素;受试者工作特征(ROC)曲线分析IGF-1、TSH和HOMA-IR预测T2DM合并甲状腺结节患者TI-RADS分级的效能。结果甲状腺结节组IGF-1、TSH和HOMA-IR明显高于非甲状腺结节组[(185.35 ± 45.08)ng/L比(168.36 ± 30.25)ng/L、(2.98 ± 0.85)mU/L比(2.69 ± 0.35) mU/L和3.25 ± 0.75比2.95 ± 0.44],差异有统计学意义(P<0.05或<0.01)。T2DM合并甲状腺结节患者随着TI-RADS分级的升高IGF-1、TSH和HOMA-IR逐渐升高,各级间比较差异有统计学意义(P<0.05)。Spearman相关分析结果显示,IGF-1、TSH和HOMA-IR水平与TI-RADS分级呈正相关(r = 0.918、0.906和0.920,P<0.05)。多因素Logistic回归分析结果显示,IGF-1、TSH和HOMA-IR是影响T2DM合并甲状腺结节患者TI-RADS分级的独立危险因素(OR = 1.684、1.044和1.851,95%CI 0.674~6.665、0.032~0.055和1.212~2.298,P<0.01或<0.05)。ROC曲线分析结果显示,IGF-1、TSH、HOMA-IR预测T2DM合并甲状腺结节患者TI-RADS分级的曲线下面积为0.946、0.983和0.975,灵敏度均为100.00%,特异度为82.14%、91.07%和89.29%。结论 T2DM合并甲状腺结节患者血清IGF-1、TSH及HOMA-IR与TI-RADS分级有一定的相关性,对甲状腺结节变化的临床监测有一定指导价值。

Objective To investigate the correlation between serum insulin-like growth factor 1(IGF-1),thyroid stimulating hormone(TSH),degree of insulin resistance and thyroid nodule imaging reporting and data system(TI-RADS)grading in patients with type 2 diabetes mellitus(T2DM).Methods The clinical data of 120 patients with T2DM from February 2020 to November 2021 in Kunshan Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively analyzed.Among them,56 patients had no thyroid nodules(non-thyroid nodule group),all patients were TI-RADS grade 1;64 patients had thyroid nodules(thyroid nodule group),including 7 cases of TI-RADS grade 2,12 cases of TI-RADS grade 3,20 cases of TI-RADS grade 4,and 25 cases of TI-RADS grade 5.The levels of IGF-1 and TSH were measured by automated biochemical analyzer,the homeostatic model assessment insulin resistance index(HOMA-IR)was calculated.Spearman method was used for correlation analysis;multivariate Logistic regression was used to analyze the independent risk factors of TI-RADS grading in patients with T2DM combined with thyroid nodules;the receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of IGF-1,TSH and HOMA-IR in predicting TI-RADS grading in patients with T2DM combined with thyroid nodules.Results The IGF-1,TSH and HOMA-IR in thyroid nodule group were significantly higher than those in non-thyroid nodule group:(185.35±45.08)ng/L vs.(168.36±30.25)ng/L,(2.98±0.85)mU/L vs.(2.69±0.35)mU/L and 3.25±0.75 vs.2.95±0.44,and there were statistical differences(P<0.05 or<0.01).In patients with T2DM combined with thyroid nodules,with the increase of TI-RADS classification,the IGF-1,TSH and HOMA-IR gradually increased,and there were statistical differences(P<0.05).Spearman correlation analysis result showed that the levels of IGF-1,TSH and HOMA-IR were positive correlation with TI-RADS grading(r=0.918,0.906 and 0.920;P<0.05).Multivariate Logistic regression analysis result showed that the IGF-1,TSH and HOMA-IR were independent risk factors for TI-RADS grading in patients with T2DM combined with thyroid nodule(OR=1.684,1.044 and 1.851;95%CI 0.674 to 6.665,0.032 to 0.055 and 1.212 to 2.298;P<0.01 or<0.05).ROC curve analysis result show that the area under the curve of IGF-1,TSH and HOMA-IR for predicting the TI-RADS grading patients with T2DM combined with thyroid nodule were 0.946,0.983 and 0.975,with all sensitivity of 100.00%,and specificity of 82.14%,91.07%and 89.29%.Conclusions There is a correlation between IGF-1,TSH,HOMA-IR and TI-RADS grading in patients with T2DM combined with thyroid nodule,which has some guiding value for clinical monitoring of thyroid nodule changes.