二甲双胍对甲状腺功能正常的2型糖尿病患者血清促甲状腺激素水平的影响  

Effect of metformin on serum thyrotropin in type 2 diabetes patients with euthyroidism

作　　者：杨丽娟[1] 陈静[1] 陶红[1] Yang Lijuan;Chen Jing;Tao Hong(Department of Endocrinology and Metabolism,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院内分泌代谢科,100029

出　　处：《中国综合临床》2020年第6期481-485,共5页Clinical Medicine of China

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2013-3-008);首都卫生发展科研专项项目(首发2014-2-1054)。

摘　　要：目的观察二甲双胍治疗对甲状腺功能正常的2型糖尿病患者血清促甲状腺激素(thyroid stimulating hormone,TSH)水平的影响。方法采用回顾性病例对照研究分析2014年6月至2018年6月就诊于首都医科大学附属北京安贞医院内分泌代谢科的甲状腺功能正常的新诊断或首次接受二甲双胍治疗的2型糖尿病患者180例的临床资料。根据降糖治疗方案不同分为二甲双胍组及非二甲双胍组,每组各90例。二甲双胍组根据基线TSH水平又分为高TSH(基线TSH>2.50 mU/L~≤4.91 mU/L)亚组36例,及低TSH(基线TSH≥0.49 mU/L~≤2.50 mU/L)亚组54例,并对高TSH亚组根据甲状腺过氧化物酶抗体(antithyroid peroxidase antibody,TPOAb)水平作进一步分组分析。治疗12个月。观察患者基线及治疗12个月时TSH、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)及游离甲状腺素(free thyroxine,FT4)指标变化。结果二甲双胍组与非二甲双胍组基线时血清TSH及甲状腺激素水平与治疗12个月时比较差异均无统计学意义(P均>0.05)。二甲双胍组患者行亚组分析,仅高TSH亚组二甲双胍治疗12个月后TSH浓度(2.31±1.48)mU/L较基线浓度(3.19±0.62)mU/L相比下降,差异有统计学意义(t=3.291,P=0.002);进一步分组分析提示,无论TPOAb阳性或阴性,高TSH亚组治疗后TSH水平较治疗前下降均具有统计学意义[高TSH-TPOAb(+):(1.92±1.27)mU/L与(3.34±0.56)mU/L,t=3.235,P=0.005;高TSH-TPOAb(-):(2.36±1.50)mU/L与(3.16±0.63)mU/L,t=2.507,P=0.016]。结论二甲双胍治疗能够降低基线TSH水平正常偏高的甲状腺功能正常的2型糖尿病患者的TSH水平,且TPOAb水平对该作用无影响。Objective To investigate the influence of metformin on serum thyrotropin(TSH)levels in type 2 diabetes patients with euthyroidism.Methods A retrospective case-control study was conducted to analyze the clinical data of 180 patients with type 2 diabetes who were newly diagnosed with normal thyroid function or first treated with metformin from June 2014 to June 2018 in the endocrine metabolism Department of Beijing Anzhen Hospital Affiliated to Capital Medical University.The patients were divided into metformin group and non metformin group according to the different treatment plan,90 cases in each group.According to the baseline TSH level,the metformin group was divided into 36 cases of high TSH(baseline TSH>2.50 mU/L-≤4.91 mU/L)and 54 cases of low TSH(baseline TSH≥0.49 mU/L-≤2.50 mU/L).The high TSH group was further grouped and analyzed according to the level of thyroid peroxidase antibody(TPOAb).Treatment for 12 months.The changes of TSH,FT3 and FT4 were observed at baseline and 12 months after treatment.Results There was no significant difference in serum TSH and thyroid hormone between metformin group and non metformin group at baseline and 12 months after treatment(all P>0.05).However,in metformin group subjects only with high-normal basal TSH level,significant decrease in TSH levels after 12-month therapy was observed((2.31±1.48)mU/L vs.(3.19±0.62)mU/L,t=3.291,P=0.002).Further grouping analysis showed that,regardless of TPOAb positive/negative,the TSH level in the high TSH subgroup decreased significantly after treatment compared with that before treatment(TPOAb(+):(1.92±1.27)mU/L vs.(3.34±0.56)mU/L,t=3.235,P=0.005)(TPOAb(-):(2.36±1.50)mU/L vs.(3.16±0.63)mU/L,t=2.507,P=0.016).Conclusion Metformin treatment reduced TSH levels in type 2 diabetic patients with normal and high baseline TSH,and TPOAb levels had no effect on this effect.

关 键 词：二甲双胍 2型糖尿病 促甲状腺激素 

分 类 号：R969[医药卫生—药理学]