脂代谢IGF-1及HbA1c水平与T2DM合并甲状腺结节性质的关系研究

The Relationship between Lipid Metabolism IGF-1 and HbA1c Levels and the Nature of T2DM Combined with Thyroid Nodules

目的:探讨2型糖尿病(T2DM)合并甲状腺结节患者脂代谢、血清胰岛素样生长因子-1(IGF-1)及糖化血红蛋白(HbA1c)水平与结节性质的关系。方法:选取2020年5月至2022年5月在我院治疗的T2DM合并甲状腺结节患者137例作为观察组,同时选取单纯T2DM患者140例作为对照组,比较两组脂代谢、IGF-1、HbA1c等差异,同时分析观察组良性和恶性结节患者脂代谢、IGF-1、HbA1c等差异。结果:观察组T2DM病程、空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、TG/HDL-C和IGF-1分别为(10.50±2.43)年、(11.40±2.11)mmoL/L、(24.49±3.32)mIU/L、(9.60±1.83)%、(12.45±2.11)、(4.14±1.02)mmoL/L、(3.05±0.92)和(220.10±70.20)ng/mL,明显高于对照组(P<0.05);观察组和对照组餐后2h血糖(2hPG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、TC/HDL-C和LDL-C/HDL-C比较差异无统计学意义(P>0.05)。观察组恶性结节患者HbA1c、TG、TG/HDL-C、IGF-1分别为(10.21±1.60)%、(4.76±1.56)mmoL/L、(3.50±0.90)和(243.32±51.26)ng/mL,明显高于良性结节患者(P<0.05)。TG、TG/HDL-C与HbA1c呈正相关(P<0.05)。IGF-1与TG、TG/HDL-C和HbA1c无明显相关性(P>0.05)。TG、TG/HDL-C、IGF-1、HbA1c预测恶性结节的ROC曲线下面积分别为0.621、0.705、0.727、0.687,P<0.05。结论:T2DM合并甲状腺结节患者脂代谢异常明显,IGF-1和HbAIc明显升高,其中TG、TG/HDL-C、IGF-1和HbA1c在预测甲状腺结节良恶性病变方面有一定应用价值。

Objective:To investigate the relationship between lipid metabolism,serum levels of insulin-like growth factor-1(IGF-1)and glycosylated hemoglobin(HbA1c)and the nature of thyroid nodules in patients with type 2 diabetes mellitus(T2DM).Methods:137 patients with T2DM combined with thyroid nodules treated in our hospital from May 2020 to May 2022 were selected as the observation group,while 140 patients with T2DM alone were selected as the control group,the differences in lipid metabolism,IGF-1,HbA1c,etc.between the two groups were compared,and the differences in lipid metabolism,IGF-1,HbA1c,etc.between patients with benign and malignant nodules in the observation group were analyzed.Results:The course of T2DM,fasting blood glucose(FBG),fasting insulin(FINS),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),triglyceride(TG),TG/HDL-C and IGF-1 in the observation group were(10.50±2.43)years,(11.40±2.11)mmol/L,(24.49±3.32)mIU/L,(9.60±1.83)%,(12.45±2.11),(4.14±1.02)mmol/L,(3.05±0.92)and(220.10±70.20)ng/ml,respectively,which was significantly higher than that in the control group(P<0.05).There was no significant difference between the observation group and the control group in blood glucose at 2h after meal(2hPG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),TC/HDL-C and LDL-C/HDL-C(P>0.05).HbA1c,TG,TG/HDL-C and IGF-1 in patients with malignant nodules of observation group were(10.21±1.60)%,(4.76±1.56)mmol/L,(3.50±0.90)and(243.32±51.26)ng/ml,respectively,higher than those in patients with benign nodules(P<0.05).TG,TG/HDL-C were positively correlated with HbA1c(P<0.05).IGF-1 had no significant correlation with TG,TG/HDL-C and HbA1c(P>0.05).The area under ROC curve predicted by TG,TG/HDL-C,IGF-1,HbA1c to predict malignant nodules were 0.621,0.705,0.727,0.687 respectively(P<0.05).Conclusion:In T2DM patients with thyroid nodules,lipid metabolism is significantly abnormal,IGF-1 and HbAIc are significantly increased,and TG,TG/HDL-C,IGF-1 and HbA1c has certain application value in predicting benign and malignant thyroid nodules.