甲状腺功能正常2型糖尿病患者的机体甲状腺轴微紊乱情况研究  

Clinical study on thyroid axis micro-disorder in euthyroid patients with type 2 diabetes mellitus

作　　者：刘志文[1] 刘巧蕊[1] 吴荔茗[1] 马聪[1] 那日苏[1] 郑旭磊[1] 郭攻[1] 

机构地区：[1]上海市徐汇区中心医院内分泌科,200031

出　　处：《河北医药》2017年第14期2109-2112,共4页Hebei Medical Journal

基　　金：上海市卫计委课题(编号:201440282)

摘　　要：目的观察甲状腺功能正常的2型糖尿病(T2DM)患者甲状腺轴激素微紊乱及其对胰岛素抵抗的影响。方法选择2014年7月至2016年7月确诊的初诊T2DM患者80例作为T2DM组;选择同期被OGTT实验证实为糖耐量异常的健康体检者40例作为IGT组;同期体检血糖在正常范围的40例作为健康对照组。观察T2DM组,IGT组和健康对照组3组机体三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4),促甲状腺素(TSH),稳态模型评价胰岛素抵抗(HOMA-IR)和糖化血红蛋白(Hb A1c)水平的变化,T2DM患者的T3,FT4,TSH水平与HOMA-IR和Hb A1c水平的相关性,及其治疗后水平的变化。结果 T2DM组和IGT组的FT3和FT4水平明显低于健康对照组(P<0.01),T2DM组水平明显低于IGT组(P<0.01),治疗后T2DM机体的FT3和FT4水平较治疗前明显提高(P<0.01);而TSH,HOMA-IR和Hb A1c水平明显高于健康对照组(P<0.01),T2DM组水平明显高于IGT组(P<0.01),治疗后T2DM患者机体的TSH,HOMA-IR和Hb A1c水平明显较治疗前降低(P<0.01)。T2DM患者机体的FT3,FT4和HOMA-IR水平随着Hb A1c水平的升高而出现明显升高(P<0.01),而TSH水平随着Hb A1c水平的升高而降低(P<0.01)。胰岛素抵抗组的FT3和FT4水平明显低于非胰岛素抵抗组(P<0.01),而TSH和Hb A1c水平明显高于非胰岛素抵抗组(P<0.01)。结论甲状腺功能正常的T2DM患者机体存在甲状腺轴功能的微紊乱,其紊乱程度与糖尿病严重程度和胰岛素抵抗指数相关,控制T2DM后机体的甲状腺轴紊乱得到纠正。Objective To observe thyroid axis micro-disorder in euthyroid patients with type 2 diabetes mellitus（ T2DM） and its effects on insulin resistance. Methods Eighty euthyroid patients with T2DM who were treated in our hospital from July 2014 to July 2016 were selected as T2DM group,at the same time,40 patients with glucose tolerance abnormality were served as IGT group,moreover,40 healthy subjects with normal blood glucose levels were served as control group. The levels of the free three triiodothyronine（ FT3）,free thyroxine（ FT4）,thyroid stimulating hormone（ TSH） were detected,moreover,insulin resistance（ HOMA-IR） and hemoglobin（ Hb A1c） were evaluated by means of homeostasis model a ssessment in the three groups,besides,the correlation between the levels of T3,FT4,TSH and the levels of HOMA-IR and Hb A1 c in patients with T2MD was analyzed. Results The levels of FT3 and FT4 in T2DM group and IGT group were significantly lower than those in control group（ P 〈0. 01）,moreover,which in T2DM group were significantly lower than those in IGT group（ P 〈0. 01）. After treatment the levels of FT3 and FT4 in T2DM group were significantly increased,as compared with those before treatment（ P 〈0. 01）,and the levels of TSH,HOMA-IR and Hb A1 c in T2DM group and IGT group were significantly higher than those in control group（ P〈 0. 01）,moreover,which in T2DM group were significantly higher than those in IGT group（ P〈 0. 01）. After treatment the levels of TSH,HOMA-IR and Hb A1 c were significantly decreased,as compared with those before treatment（ P〈 0. 01）. The levels of FT3,FT4 and HOMA-IR in T2DM group were increased with the increase of Hb A1c（ P 〈0. 01）,however,the TSH levels were decreased with the increase of Hb A1 c levels（ P〈 0. 01）.The levels of FT3 and FT4 in insulin resistant group were significantly lower than those in non-insulin resistant group（ P〈 0. 01）,however,the TSH and Hb A1 c levels in insulin resistant group were significantly higher

关 键 词：2型糖尿病 甲状腺功能 胰岛素抵抗 甲状腺轴 

分 类 号：R587.1[医药卫生—内分泌]