摘要
目的 探讨2型糖尿病患者病情严重程度以及胰岛素抵抗与甲状腺功能的关系.方法 选取我院内分泌科诊治的2型糖尿病患者500例（病例组）以及健康体检的正常者60例（正常组）为观察对象.检测两组入选对象的空腹血游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）、促甲状腺激素（TSH）、甲状腺相关抗体[甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）];2型糖尿病组患者同时化验血胰岛素、糖化血红蛋白（HbA1c）,并测定尿肌酐（UCr）和微量白蛋白（UMA）等.结果 病例组的FT3（4.14±1.52） pmol/L和TSH（2.10±1.33） mIU/L水平较正常组FT3（4.53±0.72） pmol/L和TSH（1.78±0.97） mIU/L相比较,两组均存在统计学差异（P值分别为0.03、0.025）;严重血糖升高者血FT3明显下降,HbA1c〉11%组FT3（3.76±0.78） pmol/L,HbA1c≤7%组（4.37±0.78） pmol/L、7%~9%组（4.24±0.62） pmol/L、9%~11%组（4.36±1.68） pmol/L,差异有统计学意义（P值为0.014,0.009和0.000）;尿MA/Cr越高,血清FT3下降越明显,微量蛋白尿组（30 mg/g≤尿MA/Cr〈300 mg/g）和大量蛋白尿组（尿MA/Cr≥300 mg/g）的FT3水平分别为（4.00±0.79） pmol/L和（3.50±0.76） pmol/L与尿MA/Cr〈30 mg/g组患者FT3（4.31±0.18） pmol/L相比差异有统计学意义（P值为0.041和0.001）,尿MA/Cr≥300 mg/g组血FT3水平较30 mg/g≤尿MA/Cr〈300 mg/g组明显下降（P=0.044）;血清TSH与胰岛素抵抗指数（HOMA-IR）之间有正相关性（r=0.302,P=0.001）.结论 血清FT3是血糖严重升高的标志,可以预判糖尿病肾病的严重程度;血TSH与HOMA-IR密切相关.
Objective To study the relationship between thyroid function and disease severity or insulin resistance in patients with type 2 diabetes.Methods A total of 500 patients with type 2 diabetes and 60 normal controls were enrolled in our study.Fasting blood free three iodine thyroid original thyroid hormones（FT3） and free amino acid（FT4）,thyroid stimulating hormone（TSH）,thyroid related antibodies（thyroid peroxidase antibody（TPOAb） and thyroglobulin antibody（TGAb）） of two groups of selected objects were detected.In patients with type 2 diabetes group,blood insulin,glycated hemoglobin（HbA1c）,and the determination of trace albumin urine creatinine（UCr） and （UMA） were assayed.Results FT3 and TSH of control group was （4.14±1.52） pmol/L,（2.10±1.33） mIU/L,but the level of case group was （4.53±0.72） pmol/L,（1.78±0.97） mIU/L respectively,the difference between case group and control group of serum FT3 and TSH were statistically significant（P=0.03,0.025）.The serum FT3 significantly decreased in patients with high blood sugar,the difference between HbA1C〉11% group（FT3=（3.76±0.78） pmol/l） and HbA1C≤7%（FT3=（4.37±0.78） pmol/l）,7-9%（FT3=（4.24±0.62） pmol/l）,9-11% （FT3=（4.36±1.68） pmol/l） groups were statistically significant（P=0.014,0.009,0.000）.The higher urine MA/Cr,the more serum FT3 decreased,the difference between urine MA/Cr〈30 mg/g group（FT3=（4.31±0.18） pmol/l） and 30 mg/g≤MA/Cr〈300 mg/g（FT3=（4.00±0.79） pmol/l）,MA/Cr≥300 mg/g （FT3=（3.50±0.76） pmol/l） groups were statistically significant（P=0.041,0.001）.The differences between MA/Cr≥300 mg/g group and 30 mg/g≤MA/Cr〈300 mg/g group was statistically significant（P=0.044）.In addition,we found a correlation between serum TSH and insulin resistance index（HOMA-IR）（r=0.302,P=0.001）.Conclusion As a sign of serious high blood sugar,it can predict the severity of diabetic nephropathy.There is intimate relationship of serum TSH an
作者
史良凤
王传杰
Shi Liangfeng Wang Chuanjie(Jinshan Hospital of Fudan University, Shanghai,201508, China)
出处
《中国综合临床》
2017年第4期323-326,共4页
Clinical Medicine of China
基金
复旦大学附属金山医院院级课题[2014-13（院）]
关键词
2型糖尿病
甲状腺功能
严重程度
胰岛素抵抗
Type 2 diabetes
Thyroid function
Disease severity
Insulin resistance
