2型糖尿病合并甲状腺功能亢进患者血清Sema 5A、IGFBP-3水平与糖代谢指标的相关性分析

Correlation analysis of serum Sema 5A and IGFBP-3 levels with glucose metabolism indexes in patients with type 2 diabetes mellitus complicated with hyperthyroidism

目的分析2型糖尿病合并甲状腺功能亢进(以下简称甲亢)患者血清信号素5A(Sema 5A)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平与糖代谢指标的相关性。方法选取2021年6月至2022年6月邯郸市中心医院收治的73例2型糖尿病合并甲亢患者作为合并组,56例单纯2型糖尿病患者作为糖尿病组,另选取同期在邯郸市中心医院体检的68例健康者作为对照组。比较对照组、糖尿病组、合并组血清Sema 5A、IGFBP-3水平,比较糖尿病组、合并组临床资料[体质量指数、糖尿病病程、空腹血糖(FBG)、餐后2 h血糖(2 h PG)、胰岛素(FIN)、甘油三酯、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)、三碘甲腺原氨酸(T_(3))、甲状腺素(T_(4))、游离三碘甲腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺素(TSH)、促甲状腺激素受体抗体(TRAB)及甲状腺过氧化物酶抗体(TPOAB)、胰岛素抵抗指数(HOMA-IR)]。采用多因素Logisitic回归分析2型糖尿病并发甲亢的危险因素,采用Pearson相关分析2型糖尿病合并甲亢患者血清Sema 5A、IGFBP-3水平与糖代谢指标的相关性,绘制受试者工作特征(ROC)曲线分析血清Sema 5A、IGFBP-3对2型糖尿病合并甲亢的诊断价值。结果合并组血清Sema 5A、IGFBP-3水平高于对照组和糖尿病组,且糖尿病组高于对照组,差异均有统计学意义(P<0.05)。合并组糖尿病病程长于糖尿病组,血清HOMA-IR、FIN、HbA1c、T_(3)、T_(4)、FT_(3)、FT_(4)、TRAB、TPOAB水平高于糖尿病组,TSH水平低于糖尿病组,差异均有统计学意义(P<0.05)。多因素Logisitic回归分析结果显示,HOMA-IR、TPOAB、Sema 5A、IGFBP-3水平升高,TSH水平降低为2型糖尿病并发甲亢的危险因素(P<0.05)。Pearson相关分析结果显示,2型糖尿病并发甲亢患者血清Sema 5A、IGFBP-3水平与HOMA-IR、FBG、2 h PG、FIN、HbA1c、HDL-C水平均呈正相关(P<0.05)。2型糖尿病并发甲亢患者血清Sema 5A、IGFBP-3水平与LDL-C水平呈负相关(P<0.05)。ROC曲线分析结果显示,血清Sema 5A、IGFBP-3诊断2型糖尿病合并甲亢的曲线下面积(AUC)分别为0.854、0.804,2项指标联合诊断的AUC为0.900,且2项指标联合诊断的AUC高于Sema 5A、IGFBP-3单独诊断的AUC(Z联合-Sema 5A=2.156,P=0.043;Z联合-IGFBP-3=2.873,P=0.004)。结论2型糖尿病合并甲亢患者血清Sema 5A、IGFBP-3水平升高,且二者与糖代谢指标密切相关。

Objective To analyze the correlation of serum semsemin 5A(Sema 5A)and insulin-like growth factor binding protein-3(IGFBP-3)levels with glucose metabolism indexes in patients with type 2 diabetes mellitus and hyperthyroidism.Methods A total of 73 patients with type 2 diabetes combined with hyperthyroidism admitted to Handan Central Hospital from June 2021 to June 2022 were selected as the combination group,and 56 patients with simple type 2 diabetes were selected as the diabetes group,and 68 healthy people who underwent physical examination in Handan Central Hospital during the same period were selected as the control group.The serum Sema 5A and IGFBP-3 levels were compared among the control group,diabetes group and combined group.The clinical data[body mass index,duration of diabetes,fasting blood glucose(FBG),2 hour postprandial blood glucose(2 h PG),insulin(FIN),triglyceride,total cholesterol,low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),glycosylated hemoglobin(HbA1c),triiodothyronine(T_(3)),tetraiodothyronine(T_(4)),free triiodothyronine(FT_(3)),free tetraiodothyronine(FT_(4)),thyroid stimulating hormone(TSH),thyroid stimulating hormone receptor antibody(TRAB),thyroid peroxidase antibody(TPOAB),insulin resistance index(HOMA-IR)].Multivariate Logistic regression was used to analyze the risk factors of type 2 diabetes complicated with hyperthyroidism.Pearson correlation was used to analyze the correlation between serum Sema 5A,IGFBP-3 levels and glucose metabolism indexes in patients with type 2 diabetes mellitus complicated with hyperthyroidism.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of serum Sema 5A and IGFBP-3 in type 2 diabetes mellitus with hyperthyroidism.Results The serum Sema 5A and IGFBP-3 levels in the combined group were significantly higher than those in the control group and the diabetes group,and those in the diabetes group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).Serum HOMA-IR,FIN,HbA1c,T_(3),T_(4),FT_(3),FT_(4),TRAB and TPOAB levels in the combined group were higher than those in the diabetes group,and TSH level in the combined group was lower than that in the diabetes group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that seum HOMA-IR,TPOAB,Sema 5A,IGFBP-3 levels increased,and TSH level decreased were risk factors for hyperthyroidism in type 2 diabetes mellitus(P<0.05).Pearson correlation analysis showed that serum Sema 5A and IGFBP-3 levels were positively correlated with HOMA-IR,FBG,2 h PG,FIN,HbA1c and HDL-C levels(P<0.05).Serum Sema 5A and IGFBP-3 levels were negatively correlated with LDL-C level(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum Sema 5A and IGFBP-3 in the diagnosis of type 2 diabetes mellitus with hyperthyroidism was 0.854 and 0.804 respectively.The AUC of the combination of the two indicators was 0.900.The AUC of the combined diagnosis of the two indicators was higher than the AUC of Sema 5A or IGFBP-3 diagnosed alone(Z combination-Sema 5A=2.156,P=0.043;Z combination-IGFBP-3=2.873,P=0.004).Conclusion The serum Sema 5A and IGFBP-3 levels are increased in type 2 diabetes patients with hyperthyroidism,and they are closely related to glucose metabolism.