原发性甲状腺功能减退症患者胰岛素抵抗情况及影响因素分析  

Insulin resistance and influencing factors of patients with hypothyroidism

作　　者：邵莉莉 刘思嘉 王亭亭[1] 李冲[1] Shao Lili;Liu Sijia;Wang Tingting;Li Chong(Department of General Practice, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院全科医学科,450052

出　　处：《中国实用医刊》2019年第11期17-21,共5页Chinese Journal of Practical Medicine

摘　　要：目的探讨原发性甲状腺功能减退症患者糖脂代谢变化、胰岛素抵抗情况并分析其影响因素。方法选取2017年3月至2018年3月至郑州大学第一附属医院就诊的原发性甲状腺功能减退症患者125例作为观察组,另随机选取同期健康体检者60例作为对照组,比较两组一般资料和空腹血糖(FBG)、餐后2h血糖(2hBG)、空腹胰岛素(FINS)、餐后2h胰岛素(2hINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素敏感性指数(ISI)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)的差异,采用Pearson相关分析计算HOMA-IR与各观察指标的相关系数,采用Logistic回归分析探讨原发性甲状腺功能减退症患者胰岛素抵抗的影响因素,通过受试者工作特征(ROC)曲线分析促甲状腺激素(TSH)预测原发性甲状腺功能减退症患者胰岛素抵抗的可能切点。结果观察组体质指数(BMI)、FBG、FINS、2hINS、HOMA-IR、TC、TG、LDL-C高于对照组(P<0.05),ISI、HDL-C低于对照组(P<0.05)。HOMA-IR与游离甲状腺素(FT4)、ISI呈负相关(r=-0.278、-0.599,P<0.05),与BMI、TSH、FBG、TC、LDL-C呈正相关(r=0.367、0.456、0.365、0.270、0.295,P<0.05)。校正性别、年龄、BMI、FT4、TC、LDL-C等因素的影响后,TSH(OR=1.040,95%CI1.004~1.078,P<0.05)是甲状腺功能减退症患者胰岛素抵抗的独立危险因素。10.11μU/ml是TSH预测甲状腺功能减退症胰岛素抵抗的可能切点,其敏感度及特异度分别为94.7%、58.9%。结论甲状腺功能减退症患者较健康人群更易发生糖脂代谢异常和胰岛素抵抗,TSH是甲状腺功能减退症患者胰岛素抵抗的独立危险因素,当TSH>10.11μU/ml时,应当监测患者的糖脂代谢指标,以便尽早识别及干预治疗,降低相关疾病发生率。Objective To investigate the changes in glucose and lipid metabolism, insulin resistance in patients with hypothyroidism and analyze the influencing factors. Methods A total of 125 patients with hypothyroidism in the First Affiliated Hospital of Zhengzhou University from March 2017 to March 2018 were selected as observation group. Sixty healthy individuals were selected as control group. The differences in the general information, the fasting blood glucose (FBG), fasting insulin (FINS), 2 h postprandial glucose (2 h BG), 2 h postprandial insulin (2 h INS), homeostasis model of assessment for insulin resistance index (HOMA-IR), insulin sensitivity index (ISI), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) were compared between the two groups. Pearson correlation analysis was applied to analyse the relationship between HOMA-IR and other indicators. The influencing factors of insulin resistance in patients with hypothyroidism were analyzed by Logistic regression analysis. Receiver operator characteristic (ROC) curve was drawn to determine the cut-off point of thyroid stimulating hormone (TSH) for detecting insulin resistance in patients with hypothyroidism. Results Body mass index (BMI), FBG, FINS, 2 h INS, HOMA-IR, TC, TG, LDL-C in observation group were significantly higher than those in control group (P<0.05), while ISI, HDL-C were significantly lower than those in control group (P<0.05). HOMA-IR was negatively correlated with free thyroxine 4 (FT4) and ISI (r=-0.278,-0.599, P<0.05), and positively correlated with BMI, TSH, FBG, TC, LDL-C (r=0.367, 0.456, 0.365, 0.270, 0.295, P<0.05). TSH (OR=1.040, 95%CI 1.004-1.078, P<0.05) was an independent risk factor of insulin resistance in hypothyroidism patients without consideration with gender, age, BMI, FT4, TC and LDL-C. The optimal cut-off point of TSH for detecting insulin resistance in patients with hypothyroidism was 10.11 μU/ml with the sensitivity of 94.7% and specificity of

关 键 词：甲状腺功能减退症 胰岛素抵抗 影响因素 

分 类 号：R581.2[医药卫生—内分泌]