2型糖尿病合并肥胖患者的甲状腺轴微紊乱及其对胰岛素抵抗的影响  

Micro-disorders of thyroid axis in patients with type 2 diabetes and obesity,and their impact on insulin resistance

作　　者：龚敏[1] 王爱华[1] 李秀财[1] 

机构地区：[1]上海市浦东医院,复旦大学附属浦东医院内分泌科,上海201399

出　　处：《河北医科大学学报》2017年第1期6-10,共5页Journal of Hebei Medical University

基　　金：浦东新区科委资助项目(PKJ2013-Y42)

摘　　要：目的观察2型糖尿病(type 2 diabetes mellitus,T2DM)合并肥胖患者的甲状腺轴微紊乱及其对胰岛素抵抗的影响。方法选择初发肥胖T2DM患者200例为T2DM组和符合肥胖者的健康体检者100例为糖耐量正常(normal glucose tolerance,NGT)组。比较T2DM组和NGT组血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺素(thyroid stimulating hormone,TSH)、稳态胰岛素评价指数(homeostasis model of assessment for insulin resistance,HOMA-IR)及糖化血红蛋白(hemoglobin A1c,HbA_1c)水平,比较不同HbA_1c水平T2DM患者血清FT3、FT4、TSH、HOMA-IR水平,观察甲状腺激素与HOMA-IR的相关性。结果T2DM组FT3和FT4水平明显低于NGT组,TSH、HOMA-IR和HbA_1c水平明显高于NGT组(P<0.05)。T2DM患者FT3和FT4水平随着HbA_1c水平增高而降低,TSH、HOMA-IR随着HbA_1c水平增高而增高(P<0.05)。治疗后T2DM患者FT3、FT4水平明显高于治疗前,TSH、HOMA-IR和HbA_1c水平明显低于治疗前(P<0.05)。T2DM患者FT3和FT4水平与HOMA-IR呈负相关(r=-0.781、-0.564,P<0.05),TSH水平与HOMA-IR呈正相关(r=0.648,P<0.05)。结论 T2DM合并肥胖患者存在甲状腺轴微紊乱和胰岛素抵抗,甲状腺轴微紊乱与胰岛素抵抗具有明显相关性,治疗T2DM有助于缓解甲状腺轴微紊乱和胰岛素抵抗。Objective To observe the micro-disorders of thyroid axis in patients with type 2 diabetes mellitus（T2DM） and obesity, and their impact on insulin resistance. Methods Two hundred patients with T2DM and first discovery of obesity were selected as T2DM group. One hundred obesity persons were selected as normal glucose tolerance （NGT） group at the same period. The levels of free triiodothyronine （FT3）, free thyroxine （FT4）, thyroid stimulating hormone （TSH）, homeostasis model of assessment for insulin resistance （HOMA-IR） and hemoglobin Alc（HbAlc） were observed in T2DM and NGT group before and after treatment. The levels of FT3, FT,, TSH, HOMA-IR and HbAle were observed in T2DM group with different HbAlc levels, and the correlation between thyroid hormone and HOMA-IR were also observed. Results The levels of FT3 and FT4 in T2DM group were significantly lower than those in NGT group, and the levels of TSH, HOMA-IR and HbAlc were significantly higher than those in NGT group（P〈0.05）. The FT3 and FT4 levels decreased with the increase of HbAlc level. And the levels of TSH, HOMA-iR in T2DM group increased with the increase of HbAlc level （ P〈 0. 05 ）. After treatment, the levels of FT3 and FT4 were significantly increased compared with before treatment, while, the levels of TSH, HOMA-IR and HbA1c were significantly lower compared with those before treatment（P〈0.05）. The levels of FT3 and FT4 were negatively correlated to the levels of HOMA-IR（r = -0.781, -0.564, P〈0. 05）, and there were positively correlated between TSH and HOMA-IR levels（r=0.648, P〈0.05）. Conclusion There are thyroid axis micro disorder and insulin resistance in patients with T2DM and obesity, and thyroid axis micro disorder is correlated significantly to insulin resistance. Treatment of T2DM is helpful in alleviating the thyroid dysfunction and insulin resistance.

关 键 词：糖尿病 2型 肥胖症 甲状腺激素类 

分 类 号：R587.1[医药卫生—内分泌]