绝经后2型糖尿病患者血雌二醇及促甲状腺激素水平与胰岛素抵抗的关系

Correlations of levels of blood estradiol and thyroid stimulating hormone with insulin resistance in postmenopausal patients with type 2 diabetes mellitus

目的分析绝经后2型糖尿病(T2DM)患者血雌二醇(E2)、促甲状腺激素(TSH)水平与胰岛素抵抗(IR)的关系。方法回顾性抽取2021年1月至2022年12月洛阳市中心医院收治的135例绝经后T2DM患者为研究组,其中70例胰岛素抵抗指数(HOMA-IR)<1,65例HOMA-IR≥1。另抽取同期100例绝经后健康妇女为对照组。检测各组性激素、血糖及甲状腺激素[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]水平,并计算HOMA-IR,以HOMA-IR水平将研究组分为胰岛素抵抗组(HOMA-IR≥1)和无胰岛素抵抗组(HOMA-IR<1)。比较各组性激素、血糖、甲状腺激素水平及体质指数。结果研究组E2、催乳素、黄体生成素、促卵泡生成素、孕酮水平低于对照组(P<0.05),睾酮、空腹血糖、餐后2 h血糖、糖化血红蛋白、空腹胰岛素、HOMA-IR水平及体质指数高于对照组(P<0.05)。研究组FT3、FT4水平高于对照组(P<0.05),TSH水平低于对照组(P<0.05)。胰岛素抵抗组体质指数、孕酮、FT3、FT4、TSH水平高于无胰岛素抵抗组(P<0.05),E2水平低于无胰岛素抵抗组(P<0.05)。Pearson检验结果显示,E2与HOMA-IR呈负相关(r=-0.42,P<0.001),TSH与HOMA-IR呈正相关(r=0.30,P<0.001)。结论绝经后T2DM患者血TSH、E2水平与IR有关,临床需加强对甲状腺激素、性激素等指标的关注与监测,针对出现激素紊乱患者及时采取干预措施,以延缓疾病进展。

Objective To analyze the correlations of the levels of serum estradiol(E2)and thyroid stimulating hormone(TSH)with insulin resistance(IR)in postmenopausal patients with type 2 diabetes mellitus(T2DM).Methods A total of 135 postmenopausal T2DM patients admitted to Luoyang Central Hospital from January 2021 to December 2022 were retrospectively selected as the study group,including 70 cases with insulin resistance index(HOMA-IR)<1 and 65 cases with HOMA-IR≥1.In addition,100 healthy postmenopausal women were selected as the control group during the same period.The levels of sex hormones,blood glucose and thyroid hormones including free triiodothyronine(FT3),free thyroxine(FT4)and thyroid stimulating horrnone(TSH)in each group were measured,and the HOMA-IR was calculated.The study group was further divided into the insulin resistance group(HOMA-IR≥1)and the non-insulin resistance group(HOMA-IR<1)according to the level of HOMA-IR.The levels of sex hormones,blood glucose,thyroid hormones and body mass index were compared between the study group and the control group,and between the insulin resstance group and the non-insulin resistance group.Results The levels of E2,prolactin,luteinizing hormone,follicle-stimulating hormone and progesterone in the study group were lower than those in the control group(P<0.05);the study group had higher the levels of testosterone,fasting blood glucose,2-hour postprandial blood glucose,glycosylated hemoglobin,fasting insulin and HOMA-IR,and had higher body mass index compared with the control group(P<0.05).The levels of FT3 and FT4 in the study group were higher than those in the control group(P<0.05),but the level of TSH in the study group was lower than that in the control group(P<0.05).The levels of body mass index,progesterone,FT3,FT4 and TSH in the insulin resistance group were higher than those in the non-insulin resistance group(P<0.05),while the level of E2 in the insulin resistance group was lower than that in the non-insulin resistance group(P<0.05).The results of Pearson test showed that E2 was negatively correlated with HOMA-IR(r=-0.42,P<0.001),and revealed that TSH was positively correlated with HOMA-IR(r=0.30,P<0.001).Conclusions The levels of TSH and E2 in postmenopausal patients with T2DM are related to IR,therefore,it is necessary to strengthen monitoring on thyroid hormones and sex hormones.For patients with hormone disorders,timely interventions should be performed to prolong the progression of the disease.