甲状腺激素对2型糖尿病合并亚临床甲状腺功能减退患者胰岛素抵抗的作用

Effect of thyroid hormone on insulin resistance in type 2 diabetes patients with subclinical hypothyroidism

目的研究甲状腺激素对2型糖尿病合并亚临床甲状腺功能减退患者胰岛素抵抗的作用。方法选择2018年1月~2020年12月在聊城市第二人民医院就诊的120例2型糖尿病患者分为亚甲减轻度组(35例)、亚甲减重度组(35例)、正常组(50例)。所有患者均进行糖脂代谢指标检测、胰岛素功能检测,比较检测结果,对比不同促甲状腺激素(TSH)水平患者的左心室功能情况,并分析TSH与临床指标的相关性。结果治疗前,三组之间空腹血糖(FPG)比较差异无统计学意义(P>0.05),亚甲减重度组的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1C)、胰岛素抵抗指数(HOMA-IR)、餐后2 h血糖(2 h PG)、TSH高于亚甲减轻度组和正常组,空腹C肽、胰岛β细胞功能指数(HOMA-β)低于亚甲减轻度组和正常组,亚甲减轻度组的TC、TG、LDL-C、FINS、HbA1C、HOMA-IR、2 h PG及TSH高于正常组,空腹C肽、HOMA-β低于正常组,差异有统计学意义(P<0.05);经过治疗后,亚甲减轻度组的FPG、TC、TG、LDL-C、FINS、HbA1C、HOMA-IR、2 hPG及TSH均低于亚甲减重度组,空腹C肽、HOMA-β均高于亚甲减重度组,差异有统计学意义(P<0.05)。TSH水平>10 mIU/L的患者左室射血分数(LVEF)、左室短轴缩短率(LVFS)、左心室舒张早期二尖瓣口血液流速/左心室舒张末期流速比值(E/A)均低于TSH≤10 m IU/L的患者,差异有统计学意义(P<0.05);亚甲减轻度组、亚甲减重度组患者的TSH水平与空腹C肽、HOMA-β为负相关关系,与FPG、TC、TG、LDL-C、FINS、HbA1C、HOMA-IR、2 h PG呈正相关关系(P<0.05)。结论2型糖尿病合并亚临床甲状腺功能减退患者会出现胰岛素抵抗情况加重以及左室心功能减退的情况,甲状腺激素替代治疗有助于此类患者的糖脂代谢、胰岛素抵抗情况的改善,可为临床治疗方案的制订提供参考。

Objective To study the eff ect of thyroid hormone on insulin resistance in type 2 diabetes patients with subclinical hypothyroidism.Methods A total of 120 patients with type 2 diabetes who were treated in Liaocheng Second People’s Hospital from January 2018 to December 2020 were divided into mild subclinical hypothyroidism group,severe subclinical hypothyroidism group and normal group.All patients were tested for glucose and lipid metabolism and insulin function.The results were compared.The left ventricular function of patients with diff erent TSH levels was compared,and the correlation between TSH and clinical indicators was analyzed.Results Total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),fasting insulin(FINS),glycosylated hemoglobin(HbA1C),insulin resistance index(HOMA-IR),2h postprandial blood glucose(2hPG)and thyroid stimulating hormone(TSH)in the severe subclinical hypothyroidism group were higher than those in the subclinical hypothyroidism group and the normal group.Fasting C peptide and isletβcell function index(HOMA-β)were lower than those in the subclinical hypothyroidism group and the normal group.The above indexes in the subclinical hypothyroidism group were diff erent from those in the normal group,and the diff erence was statistically signifi cant(P<0.05).After treatment,the fasting blood glucose(FPG),TC,TG,LDL-C,FINS,HbA1C,HOMAIR,2hPG and TSH in the subclinical hypothyroidism group were lower than those in the severe subclinical hypothyroidism group,and the fasting C peptide and HOMA-βwere higher than those in the severe subclinical hypothyroidism group,the differences were statistically significant(P<0.05).The left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),left ventricular early diastolic mitral valve blood fl ow velocity/left ventricular end diastolic fl ow velocity ratio(E/A)in patients with TSH level>10 mIU/L were lower than those in patients with TSH≤10 IU/L,and the diff erences were statistically signifi cant(P<0.05).TSH level was negatively correlated with fasting C-peptide and HOMA-β,and positively correlated with other indicators above in patients with subclinical hypothyroidism and subclinical hypothyroidism,P<0.05.Conclusion Patients with type 2 diabetes mellitus complicated with subclinical hypothyroidism will have increased insulin resistance and left ventricular dysfunction.Thyroid hormone replacement therapy is helpful to improve the glucose and lipid metabolism disorder and insulin resistance of patients,which can provide reference for the formulation of clinical treatment plan.