T2DM患者GDF-15、NRG4水平对并发甲状腺功能亢进的预测价值

Predictive value of GDF-15 and NRG4 levels in patients with T2DM complicated by hyperthyroidism

目的探讨2型糖尿病(T2DM)患者生长分化因子-15(GDF-15)、神经调节蛋白4(NRG4)水平对并发甲状腺功能亢进的预测价值。方法选取本院收治的T2DM患者54例为单纯T2DM组,T2DM合并甲状腺功能亢进患者31例为T2DM合并甲亢组,健康体检者42例为对照组。比较3组甲状腺水平[促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT_(3))、游离四碘甲状腺原氨酸(FT_(4))]、血糖水平[空腹血糖(FBG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA1c)]、胰岛素抵抗指数(HOMA-IR)及GDF-15、NRG4水平;分析各指标相关性;ROC曲线评估GDF-15、NRG4对并发甲状腺功能亢进的预测价值。结果T2DM合并甲亢组FT_(3)、FT_(4)、HOMA-IR高于单纯T2DM组和对照组,TSH低于单纯T2DM组和对照组,T2DM合并甲亢组、单纯T2DM组FBG、HbA1C、2hPBG高于对照组,而GDF-15、NRG4水平T2DM合并甲亢组>单纯T2DM组>对照组(P<0.05)。T2DM合并甲状腺功能亢进患者GDF-15、NRG4与FT_(3)、FT_(4)、HOMA-IR均呈正相关(P<0.05),与TSH呈负相关(P<0.05)。GDF-15和NRG4联合预测T2DM并发甲状腺功能亢进的诊断效能高于单独预测(P<0.05)。结论血清GDF-15、NRG4对T2DM并发甲状腺功能亢进具有预测价值,尤其以二者联合预测价值最高。

Aim To explore the predictive value of growth differentiation factor-15(GDF-15)and neuregulin 4(NRG4)levels in patients with type 2 diabetes mellitus(T2DM)complicated with concurrent hyperthyroidism.Methods 54 T2DM patients were selected as the T2DM-only group,31 T2DM patients with hyperthyroidism were selected as the T2DM and hyperthyroidism group,42 cases of healthy people were selected as the control group.The thyroid levels[thyroid-stimulating hormone(TSH),free triiodothyronine(FT_(3)),free thyroid hormone(FT_(4))],blood glucose levels[fasting blood glucose(FBG),two-hour postprandial blood glucose(2hPBG)among the three groups,glycosylated hemoglobin(HbA1c)],insulin resistance index(HOMA-IR)and levels of GDF-15 and NRG4;the correlation of each index was analyzed;ROC curve was used to evaluate the predictive value of GDF-15,NRG4 for T2DM patients with hyperthyroidism.Results The levels of FT_(3)and FT_(4),HOMA-IR in the T2DM combined hyperthyroidism group were higher than those in the simple T2DM group and the healthy control group,and the TSH level was lower than that in the simple T2DM group and the healthy control group.The FBG,HbA1C and 2hPBG levels in the T2DM combined with hyperthyroidism group and the T2DM group alone were higher than those in the healthy control group.The GDF-15 and NRG4 levels were in an order of the T2DM combined group>pure T2DM group>healthy control group,and the difference was statistically significant(P<0.05).GDF-15 and NRG4 were positively correlated with FT_(3),FT_(4),and HOMA-IR in T2DM patients with hyperthyroidism(P<0.05),and negatively correlated with TSH(P<0.05).The diagnostic efficacy of combining serum GDF-15 and NRG4L in predicting T2DM complicated with hyperthyroidism is higher than that of single prediction(P<0.05).Conclusion Serum GDF-15 and NRG4 have predictive value for T2DM complicated with hyperthyroidism,especially in combination of the two.