结节性甲状腺肿病人血清脂联素、抵抗素和趋化素水平及其相关性分析

Serum levels of adiponectin,resistin and chemerinin patients with nodular goiter and their correlations

目的:探讨结节性甲状腺肿病人体内循环脂联素、抵抗素和趋化素水平及其相关性。方法:选取2017-2018年体检初发的结节性甲状腺肿病人150例和性别、年龄等一般情况相匹配的正常人150名,采集2组受试者血样,收集一般临床资料,记录并分析一般生化指标及血清脂联素、抵抗素和趋化素水平。测量并计算体质量指数(BMI)、胰岛素抵抗指数(HOMA-IR)。分析血清脂联素、抵抗素和趋化素水平与结节性甲状腺肿发病的相关性。结果:结节性甲状腺肿病人三酰甘油(TG)、低密度脂蛋白(LDL-C)、空腹血糖(FBG)、HOMA-IR、脂联素和趋化素水平均高于对照组(P<0.01),抵抗素水平低于对照组(P<0.01)。结节性甲状腺肿病人脂联素水平与空腹胰岛素(FINS)、HOMA-IR呈负相关关系(P<0.01);抵抗素水平与TG、FBG、FINS、HOMA-IR均呈负相关关系(P<0.05~P<0.01);趋化素水平与TG、FBG、FINS、HOMA-IR均呈正相关关系(P<0.01)。结节性甲状腺肿患病病例与对照组比例随四分位脂联素和趋化素浓度水平的增加而增加。抵抗素水平的最高四分之一组病例/对照组比例与最低的四分之一组相比下降。结节性甲状腺肿病人中甲亢亚组较甲状腺功能正常组游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、脂联素和趋化素均升高,促甲状腺激素(TSH)、抵抗素均降低(P<0.01),甲减亚组病人较甲状腺功能正常组TSH和趋化素均升高,FT3、FT4、抵抗素均降低(P<0.01)。甲亢亚组病人脂联素与TSH水平呈负相关关系(P<0.01);抵抗素与TSH、FBG、FINS、HOMA-IR呈负相关关系(P<0.01),与FT3、FT4呈正相关关系(P<0.01);趋化素与FT3、FT4呈负相关关系(P<0.01),与TSH、FBG、FINS、HOMA-IR呈正相关关系(P<0.01);甲减亚组脂联素、抵抗素和趋化素与FT3、FT4、TSH、TG均无明显相关性(P>0.05),脂联素和趋化素均与FBG、FINS、HOMA-IR呈负相关关系(P<0.01),抵抗素与FBG、FINS、HOMA-IR呈负相关关系(P<0.05)。结论:循环中脂联素和趋化素水平的升高和抵抗素水平的下降可能与结节性甲状腺肿的发病相关。

Objective:To investigate the serum levels of adiponectin,resistin and chemerin in patients with nodular goiter and their correlations.Methods:One hundred and fifty patients with nodular goiter initially diagnosed in physical examination from 2017 to 2018 and 150 normal people matched with gender and age were selected.Blood samples were collected from subjects in the two groups,general clinical data were collected,and general biochemical indexes and serum levels of adiponectin,resistin and chemerin were recorded and analyzed.Body mass index(BMI)and insulin resistance index(HOMA-IR)were further measured and calculated.Correlation between the serum level of adiponectin,resistin or chemerin and the pathogenesis of nodular goiter was finally analyzed.Results:Compared to subjects in the control group,patients with nodular goiter showed higher levels of triglyceride(TG),low density lipoprotein(LDL-C),fasting blood glucose(FBG),HOMA-IR,adiponectin and chemerin(P<0.01),but lower level of resistin(P<0.01).For patients with nodular goiter,the level of adiponectin was found to be negatively correlated with fasting insulin(FINS)and HOMA-IR(P<0.01);the level of resistin was found to be negatively correlated with TG,FBG,FINS and HOMA-IR(P<0.05 to P<0.01);and the level of chemerin was found to be positively correlated with TG,FBG,FINS and HOMA-IR(P<0.01).Quartile analysis showed that the proportion of cases in either the observation group or the control group increased with the increase of the levels of adiponectin and chemerin,and the level of resistin was lower in cases of the highest quartile than those of the lowest quartile in each group.In patients with nodular goiter,compared to the normal thyroid function subgroup,hyperthyroidism subgroup exhibited an increase in the level of free triiodothyronine(FT3),free thyroxine(FT4),adiponectin and chemerin,but a decrease in the level of thyroid stimulating hormone(TSH)and resistin(P<0.01).In the meantime,compared to the normal thyroid function subgroup,hypothyroidism subgroup showed higher levels of TSH and chemerin,but lower levels of FT3,FT4 and resistin(P<0.01).In hyperthyroidism subgroup,level of adiponectin was negatively correlated with level of TSH(P<0.01);level of resistin was negatively correlated with levels of TSH,FBG,FINS and HOMA-IR(P<0.01),and positively correlated with levels of FT3 and FT4(P<0.01);level of chemerin was negatively correlated with levels of FT3 and FT4(P<0.01),and positively correlated with levels of TSH,FBG,FINS and HOMA-IR(P<0.01).In hypothyroidism subgroup,while levels of adiponectin,resistin and chemerin had no significant correlation with level of FT3,FT4,TSH or TG(P>0.05),levels of adiponectin and chemerin was negatively correlated with levels of FBG,FINS and HOMA-IR(P<0.01),and level of resistin was positively correlated with levels of FBG,FINS and HOMA-IR(P<0.05).Conclusions:Increase in the serum levels of adiponectin and chemerin,and decrease in the serum level of resistin,may be related to the pathogenesis of nodular goiter.