甲状腺功能正常的非糖尿病人群甲状腺激素水平与胰岛素抵抗的关系
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摘要
目的对甲状腺功能正常的非糖尿病人群中甲状腺激素水平与胰岛素抵抗关系进行横断面研究。方法依托2011年由中华医学会发起的REACTION研究,选取大连地区符合标准的研究对象共5 428例。以促甲状腺激素(TSH)2.5mU/L为分界,分为低TSH组及高TSH组,测量两组身高、体重、血压,进行口服葡萄糖耐量(OGTT),检验血脂、血肌酐(SCr)、血尿酸(UA)、血糖、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、甲状腺功能,稳态模型评估胰岛素抵抗指数(HOMA-IR)。研究甲状腺激素水平与胰岛素抵抗的相关性。结果与低TSH组比较,高TSH组SCr、UA及游离甲状腺素(FT4)水平降低,低密度脂蛋白胆固醇(LDL-C)、胆固醇(TC)、HbA1c、FINS及HOMA-IR增高(P<0.05)。TSH、游离三碘甲状腺原氨酸(FT3)与HOMA-IR呈正相关(r=0.145、0.040,P<0.05)。而FT4水平与HOMA-IR指数呈负相关(r=-0.071,P=0.000)。回归分析显示性别、舒张压(DBP)、BMI、高密度脂蛋白胆固醇(HDL-C)、LDL-C、TC、HbA1c、UA、TSH、FT4为影响HOMA-IR的独立危险因素(P<0.05)。其中HDL-C及FT4为保护性因素(P<0.05)。结论在正常范围内的TSH水平与非糖尿病人群的胰岛素抵抗呈正相关,FT4与胰岛素抵抗呈负相关,且TSH、FT4为影响胰岛素抵抗的独立危险因素。
Objective To investigate the relationship between thyroid hormone level and insulin resistance among non-diabetic population with normal thyroid functions.Methods Relying on the REACTION Research initiated by Chinese Medical Association in 2011,totally 5 428 individuals who met the research requirements were selected in Dalian.The following data were collected,including height,weight,blood pressure,OGTT,the levels of blood lipids,blood creatinine,blood uric acid,blood glucose,glycosylated hemoglobin,fasting insulin,thyroid function indicators,and HOMA-IR.The whole group was divided into two teams,team A with TSH levels lower than 2.5 mIU/L and team B with TSH levels higher than 2.5 mIU/L.The same items above between two teams were compared.The relationship between thyroid hormone level and insulin resistance was studied.Results Compared with team A,team B had lower levels of blood creatinine,blood uric acid and FT4 and higher levels of LDL,cholesterol,glycosylated hemoglobin,fasting insulin and HOMA-IR(P <0.05).There was a positive correlation between TSH level and HOMA-IR(r =0.145,P =0.000)and a positive correlation between FT3 level and HOMA-IR as well(r=0.040,P =0.003),while there was a negative correlation between FT4 level and HOMA-IR(r =0.017,P =0.000).Logistic regression analysis showed that gender,diastolic blood pressure,BMI, HDL,LDL,cholesterol,glycosylated hemoglobin,blood uric acid,TSH and FT4 were independently the risk factors to affect HOMA-IR(P <0.05),in which HDL and FT4 were protecting factors(P <0.05).Conclusion There is a positive correlation between TSH level within normal ranges and insulin resistance of non-diabetic people,while there is a negative correlation between FT4 and insulin resistance.In addition,TSH and FT4 are the independent risk factors affecting insulin resistance.
Objective To investigate the relationship between thyroid hormone level and insulin resistance among non-diabetic population with normal thyroid functions.Methods Relying on the REACTION Research initiated by Chinese Medical Association in 2011,totally 5 428 individuals who met the research requirements were selected in Dalian.The following data were collected,including height,weight,blood pressure,OGTT,the levels of blood lipids,blood creatinine,blood uric acid,blood glucose,glycosylated hemoglobin,fasting insulin,thyroid function indicators,and HOMA-IR.The whole group was divided into two teams,team A with TSH levels lower than 2.5 mIU/L and team B with TSH levels higher than 2.5 mIU/L.The same items above between two teams were compared.The relationship between thyroid hormone level and insulin resistance was studied.Results Compared with team A,team B had lower levels of blood creatinine,blood uric acid and FT4 and higher levels of LDL,cholesterol,glycosylated hemoglobin,fasting insulin and HOMA-IR(P <0.05).There was a positive correlation between TSH level and HOMA-IR(r =0.145,P =0.000)and a positive correlation between FT3 level and HOMA-IR as well(r=0.040,P =0.003),while there was a negative correlation between FT4 level and HOMA-IR(r =0.017,P =0.000).Logistic regression analysis showed that gender,diastolic blood pressure,BMI, HDL,LDL,cholesterol,glycosylated hemoglobin,blood uric acid,TSH and FT4 were independently the risk factors to affect HOMA-IR(P <0.05),in which HDL and FT4 were protecting factors(P <0.05).Conclusion There is a positive correlation between TSH level within normal ranges and insulin resistance of non-diabetic people,while there is a negative correlation between FT4 and insulin resistance.In addition,TSH and FT4 are the independent risk factors affecting insulin resistance.
引文
[1]李霞,周智广,卞海英,等.用空腹C肽代替胰岛素改良HOMA公式评价胰岛素抵抗和胰岛细胞功能[J].中南大学学报:医学版,2004,9:419-423.
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[8]肖海英,卢艳慧,成晓玲,等.甲状腺功能正常老年男性血清促甲状腺激素水平与代谢综合征的相关性分析[J].中华医学杂志,2014,94(12):1055-1059.
[9]Fernndez-Real JM,Lpez-Bermejo A,Castro A,et al.Thyroid function is intrinsically linked to insulin sensitivity and endothelium-dependent vasodilation in healthy euthyroid subjects[J].J Clin Endocrinol Metab,2006,91(9):3337-3343.
[10]祁瑞环,黄有媛,聂庆东.早期2型糖尿病患者胰岛素抵抗与甲状腺激素水平的关系研究[J].中国全科医学,2012,15(18):2023-2025.
[11]Baeza I,Vigo L,de la Serna E,et al.The effects of antipsychotics on weight gain,weight-related hormones and homocysteine in children and adolescents:a 1-year follow-up study[J].Eur Child Adolesc Psychiatry,2017,26(1):35-46.
[12]Wanjia X,Chenggang W,Aihong W,et al.A high normal TSH level is associated with an atherogenic lipid profile in euthyroid non-smokers with newly diagnosed asymptomatic coronary heartdisease[J].Lipids Health Dis,2012,11:44.
[13]Prats-Puig A,Sitjar C,Ribot R,et al.Relative hypoadiponectinemia,insulin resistance,and increased visceral fat in euthyroid prepubertal girls with low-normal serum free thyroxine[J].Obesity(Silver Spring),2012,20(7):1455-1461.
[14]高雪,唐遇春,曾希云.老年亚临床甲状腺功能减退症患者血脂变化[J].临床荟萃,2013,28(6):667-668.
[15]王蓓蓓,姜凤伟,单忠艳,等.血清TSH水平与血脂异常的相关性研究[J].中华内分泌代谢杂志,2011,27(6):467-470.
[16]田林玉,陈晓蕾,柯亭羽.亚临床甲状腺功能减退症与2型糖尿病及其慢性并发症相关性研究进展[J].医学综述,2015,21(21):3938-3941.
[17]Chaker L,Ligthart S,Korevaar TI,et al.Thyroid function and risk of type 2 diabetes:apopulation-based prospective cohort study[J].BMC Med,2016,14(1):150.
[18]Asvold BO,Bjro T,Vatten LJ.Associations of TSH levels within the reference range with future blood pressure and lipid concentrations:11-year follow-up of the HUNT study[J].Eur J Endocrinol,2013,169(1):73-82.
[19]Temizkan S,Balaforlou B,Ozderya A,et al.Effects of thyrotrophin,thyroid hormones and thyroid antibodies on metabolicparameters in a euthyroid population with obesity[J].Clin Endocrinol(Oxf),2016,85(4):616-623.
[20]王伟,张金萍,崔莲,等.2型糖尿病患者甲状腺激素水平的变化情况及影响因素分析[J].中国糖尿病杂志,2014,22(6):514-516.
[2]Kim SR,Tull ES,Talbott EO,et al.A hypothesis of synergism:the interrelationship of T3 and insulin to disturbances in metabolic homeostasis[J].Med Hypotheses,2002,59(6):660-666.
[3]刘新民.内分泌代谢功能检查.实用内分泌学[M].2版.北京:人民军医出版社,1997:58-63.
[4]刘薇,杨金奎.亚临床甲状腺机能减退研究进展[J].临床荟萃,2007,22(4):293-296.
[5]Ruhla S,Weickert MO,Arafat AM,et al.A high normal TSH is associated with the metabolic syndrome[J].Clin Endocrinol(Oxf),2010,72(5):696-701.
[6]Maratou E,Hadjidakis DJ,Kollias A,et al.Studies of insulin resistance in patients with clinical and subclinical hypothyroidism[J].Eur J Endocrinol,2009,160(5):785-790.
[7]Roos A,Bakker SJ,Links TP,et al.Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects[J].J Clin Endocrinol Metab,2007,92(2):491-496.
[8]肖海英,卢艳慧,成晓玲,等.甲状腺功能正常老年男性血清促甲状腺激素水平与代谢综合征的相关性分析[J].中华医学杂志,2014,94(12):1055-1059.
[9]Fernndez-Real JM,Lpez-Bermejo A,Castro A,et al.Thyroid function is intrinsically linked to insulin sensitivity and endothelium-dependent vasodilation in healthy euthyroid subjects[J].J Clin Endocrinol Metab,2006,91(9):3337-3343.
[10]祁瑞环,黄有媛,聂庆东.早期2型糖尿病患者胰岛素抵抗与甲状腺激素水平的关系研究[J].中国全科医学,2012,15(18):2023-2025.
[11]Baeza I,Vigo L,de la Serna E,et al.The effects of antipsychotics on weight gain,weight-related hormones and homocysteine in children and adolescents:a 1-year follow-up study[J].Eur Child Adolesc Psychiatry,2017,26(1):35-46.
[12]Wanjia X,Chenggang W,Aihong W,et al.A high normal TSH level is associated with an atherogenic lipid profile in euthyroid non-smokers with newly diagnosed asymptomatic coronary heartdisease[J].Lipids Health Dis,2012,11:44.
[13]Prats-Puig A,Sitjar C,Ribot R,et al.Relative hypoadiponectinemia,insulin resistance,and increased visceral fat in euthyroid prepubertal girls with low-normal serum free thyroxine[J].Obesity(Silver Spring),2012,20(7):1455-1461.
[14]高雪,唐遇春,曾希云.老年亚临床甲状腺功能减退症患者血脂变化[J].临床荟萃,2013,28(6):667-668.
[15]王蓓蓓,姜凤伟,单忠艳,等.血清TSH水平与血脂异常的相关性研究[J].中华内分泌代谢杂志,2011,27(6):467-470.
[16]田林玉,陈晓蕾,柯亭羽.亚临床甲状腺功能减退症与2型糖尿病及其慢性并发症相关性研究进展[J].医学综述,2015,21(21):3938-3941.
[17]Chaker L,Ligthart S,Korevaar TI,et al.Thyroid function and risk of type 2 diabetes:apopulation-based prospective cohort study[J].BMC Med,2016,14(1):150.
[18]Asvold BO,Bjro T,Vatten LJ.Associations of TSH levels within the reference range with future blood pressure and lipid concentrations:11-year follow-up of the HUNT study[J].Eur J Endocrinol,2013,169(1):73-82.
[19]Temizkan S,Balaforlou B,Ozderya A,et al.Effects of thyrotrophin,thyroid hormones and thyroid antibodies on metabolicparameters in a euthyroid population with obesity[J].Clin Endocrinol(Oxf),2016,85(4):616-623.
[20]王伟,张金萍,崔莲,等.2型糖尿病患者甲状腺激素水平的变化情况及影响因素分析[J].中国糖尿病杂志,2014,22(6):514-516.