促甲状腺激素正常的新诊断2型糖尿病患者BMI对糖、脂代谢,肝肾、甲状腺功能的影响

Effects of body mass index on glucose and lipid metabolism,hepatic,renal and thyroid function in newly diagnosed type 2 diabetes mellitus patients with normal serum TSH

目的:探讨促甲状腺激素正常的新诊断2型糖尿病患者体重指数(body mass index,BMI)与糖、脂代谢,肝肾、甲状腺功能的关系。方法:收集2016年1月—2017年12月本院内分泌门诊156例促甲状腺激素正常的新诊断2型糖尿病患者的临床资料,按照BMI水平分为肥胖组(BMI≥28.0 kg/m2)、超重组(24.0 kg/m2≤BMI<28.0 kg/m2)、正常组(BMI<24.0 kg/m2)。分析3组患者各项代谢指标的差异以及BMI与各代谢指标的关系。结果:3组患者的丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(γ-GT)、总胆固醇(TC)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、空腹C肽(CP)、血浆促甲状腺激素(TSH)差异有统计学意义(P <0.05)。相关分析表明,在校正性别、年龄、糖化血红蛋白(HbA1c)后,随着BMI的升高,ALT、γ-GT、FINS、HOMAIR、CP、TSH也升高,呈正相关(r=0.22、0.19、0.36、0.38、0.27、0.22,P <0.05)。结论:TSH正常的新诊断2型糖尿病患者的BMI水平对机体相关代谢指标如ALT、γ-GT、TC、FINS、HOMA-IR、CP、TSH均有影响,且BMI水平与ALT、γ-GT、FINS、HOMA-IR、CP、TSH水平呈正相关。可将TSH水平作为评估新诊断的2型糖尿病患者,特别是肥胖的2型糖尿病人群代谢紊乱的参考指标和并发症随访观察的指标,及时给予适当干预。

Objective:To explore the relationship between body mass index(BMI)and different metabolic variables(glucose and lipid metabolism,hepatic,renal and thyroid function)in newly diagnosed type 2 diabetes mellitus patients with normal serum TSH.Methods:We retrospectively collected clinical data from 156 newly diagnosed type 2 diabetes mellitus patients with normal serum TSH in our center,including gender,age,BMI,alanine aminotransferase(ALT),γ-glutamyltransferase(γ-GT),blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA),fasting plasma glucose(FPG),fasting C-peptide(CP),fasting insulin(FINS),glycosylated hemoglobin A1 c(HbA1 c),insulin resistance(HOMA-IR),triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),free triiodothyronine(FT3),free thyroxin(FT4),thyroid stimulating hormone(TSH).All the patients were divided into the obesity group(BMI≥28.0 kg/m2),the overweight group(24.0 kg/m2≤BMI<28.0 kg/m2)and the normal weight group(BMI<24.0 kg/m2)according to BMI.The differences of metabolic variables among three groups and the correlation between BMI and different metabolic variables were analyzed.Results:Levels of ALT,γ-GT,TC,FINS,HOMA-IR,CP and TSH among groups were significantly different(P<0.05).After adjustment for gender,age and HBA1 c,levels of ALT,γ-GT,FINS,HOMA-IR,CP and TSH increased with the increase of BMI(r=0.22,0.19,0.36,0.38,0.27,0.22,P<0.05).Conclusion:BMI could significantly affect ALT,γ-GT,TC,FINS,HOMA-IR,CP and TSH in newly diagnosed type 2 diabetes mellitus patients with normal serum TSH.Besides,ALT,γ-GT,FINS,HOMA-IR,CP and TSH were positively correlated with BMI.TSH level could serve as an index in evaluating metabolic disorder and follow-up in newly diagnosed type 2 diabetes mellitus,especially with obesity.