亚临床甲状腺功能减退症患者及甲状腺功能正常者甲状腺功能与血糖水平的关系
아림상갑상선공능감퇴증환자급갑상선공능정상자갑상선공능여혈당수평적관계
Relationship between thyroid function and glucose level in adults with subclinical hypothyroidism and euthyroid
  • 万方数据
    中华糖尿病杂志 중화당뇨병잡지
    CHINES JOURNAL OF DLABETES MELLITUS
    2012年 3期 139-143 ,共5页

    朱雨霏%赖亚新%姜凤伟%王蓓蓓%贡鸣%张乐%孙华坤%单忠艳%滕卫平

    주우비%뢰아신%강봉위%왕배배%공명%장악%손화곤%단충염%등위평

    亚临床甲状腺功能减退症%甲状腺功能%血糖 亞臨床甲狀腺功能減退癥%甲狀腺功能%血糖
    아림상갑상선공능감퇴증%갑상선공능%혈당
    Subclinical hypothyroidism%Thyroid function%Plasma glucose
    目的 研究亚临床甲状腺功能减退症患者及甲状腺功能正常者甲状腺功能与血糖的关系.方法 采用整群抽样法于2007年至2010年从沈阳市城市成年居民中招募2751名研究对象,行问卷调查,测量血压、身高、体重、腰围、促甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺素、空腹血糖、口服葡萄糖耐量试验2h血糖、甘油三酯、总胆固醇和高密度脂蛋白胆固醇.将受试者分为亚临床甲状腺功能减退症组(n=193)及甲状腺功能正常组(n =2146),甲状腺功能正常组又进一步分为促甲状腺激素低水平组(n=352,促甲状腺激素≥0.3～＜1.0 mU/L)、促甲状腺激素中水平组(n=916,促甲状腺激素≥1.0～≤1.9 mU/L)、促甲状腺激素高水平组(n=944,促甲状腺激素1.9＜～≤4.8 mU/L).受试者根据血糖水平进一步分为糖耐量正常组、糖调节异常组、糖尿病组,分析甲状腺功能指标与血糖的关系.采用t检验及方差分析进行数据统计.结果 亚临床甲状腺功能减退症组口服葡萄糖耐量试验2h血糖明显高于甲状腺功能正常组[(8.3±4.4) vs(7.7±4.2)mmol/L,t=-2.163,P＜0.05],2组糖调节异常及糖尿病的患病率差异无统计学意义.糖尿病组游离甲状腺素水平高于糖调节异常组和糖耐量正常组[分别为(16.8±2.1)、(16.3±2.1)、(16.2±1.9)pmol/L,F=10.515,P＜0.01],女性中糖尿病组[15.3％ (26/188)]及糖调节异常组[15.0％( 34/227)]亚临床甲状腺功能减退症的患病率明显高于糖耐量正常组[9.5％ (86/903)](x2值分别为7.165、5.685,均P＜0.05),女性亚临床甲状腺功能减退症的患病率明显高于男性[11.1％ (146/1318)vs 4.6％(47/1027),x2=31.852,P＜0.01].多元线性回归分析显示,校正体质指数、腰围、血压、血脂后,总体受试者空腹血糖与游离甲状腺素呈正相关(β=2.748,P＜0.01),男性受试者空腹血糖与游离甲状腺素亦呈正相关(β=2.346,P＜0.01),女性受试者口服葡萄糖耐量试验2h血糖与游离甲状腺素呈正相关(β=2.748,P＜0.01).在正常范围内,游离甲状腺素水平越高,糖尿病的患病危险越大[总体:比值比(OR)=1.142,95％可信区间(CI)1.064～1.225,P＜0.01;女性:0R=1.147,95％ CI1.024～1.284,P＜0.05；男性:OR=1.142,95％ CI 1.035～1.261,P＜0.01].促甲状腺激素及游离三碘甲状腺原氨酸与糖尿病无关.结论 女性糖调节异常和糖尿病患者亚临床甲状腺功能减退症的患病率增高；游离甲状腺素与血糖水平呈正相关,游离甲状腺素越高,糖尿病的患病风险越大.
    목적 연구아림상갑상선공능감퇴증환자급갑상선공능정상자갑상선공능여혈당적관계.방법 채용정군추양법우2007년지2010년종침양시성시성년거민중초모2751명연구대상,행문권조사,측량혈압、신고、체중、요위、촉갑상선격소、유리삼전갑상선원안산、유리갑상선소、공복혈당、구복포도당내량시험2h혈당、감유삼지、총담고순화고밀도지단백담고순.장수시자분위아림상갑상선공능감퇴증조(n=193)급갑상선공능정상조(n =2146),갑상선공능정상조우진일보분위촉갑상선격소저수평조(n=352,촉갑상선격소≥0.3～＜1.0 mU/L)、촉갑상선격소중수평조(n=916,촉갑상선격소≥1.0～≤1.9 mU/L)、촉갑상선격소고수평조(n=944,촉갑상선격소1.9＜～≤4.8 mU/L).수시자근거혈당수평진일보분위당내량정상조、당조절이상조、당뇨병조,분석갑상선공능지표여혈당적관계.채용t검험급방차분석진행수거통계.결과 아림상갑상선공능감퇴증조구복포도당내량시험2h혈당명현고우갑상선공능정상조[(8.3±4.4) vs(7.7±4.2)mmol/L,t=-2.163,P＜0.05],2조당조절이상급당뇨병적환병솔차이무통계학의의.당뇨병조유리갑상선소수평고우당조절이상조화당내량정상조[분별위(16.8±2.1)、(16.3±2.1)、(16.2±1.9)pmol/L,F=10.515,P＜0.01],녀성중당뇨병조[15.3％ (26/188)]급당조절이상조[15.0％( 34/227)]아림상갑상선공능감퇴증적환병솔명현고우당내량정상조[9.5％ (86/903)](x2치분별위7.165、5.685,균P＜0.05),녀성아림상갑상선공능감퇴증적환병솔명현고우남성[11.1％ (146/1318)vs 4.6％(47/1027),x2=31.852,P＜0.01].다원선성회귀분석현시,교정체질지수、요위、혈압、혈지후,총체수시자공복혈당여유리갑상선소정정상관(β=2.748,P＜0.01),남성수시자공복혈당여유리갑상선소역정정상관(β=2.346,P＜0.01),녀성수시자구복포도당내량시험2h혈당여유리갑상선소정정상관(β=2.748,P＜0.01).재정상범위내,유리갑상선소수평월고,당뇨병적환병위험월대[총체:비치비(OR)=1.142,95％가신구간(CI)1.064～1.225,P＜0.01;녀성:0R=1.147,95％ CI1.024～1.284,P＜0.05；남성:OR=1.142,95％ CI 1.035～1.261,P＜0.01].촉갑상선격소급유리삼전갑상선원안산여당뇨병무관.결론 녀성당조절이상화당뇨병환자아림상갑상선공능감퇴증적환병솔증고；유리갑상선소여혈당수평정정상관,유리갑상선소월고,당뇨병적환병풍험월대.
    Objective To investigate the relationship between thyroid function and glucose level in adults with subclinical hypothyroidism and euthyroid.Methods A total of 2751 subjects completed a questionnaire survey and measurement for blood pressure,height,body weight,waist circunfference,thyroid stimulating hormone ( TSH ),free triiodothyronine ( FT3 ),free thyroxine ( FT4 ),fasting plasma glucose (FPG),oral glucose tolerance test (OGTT) 2-h glucose,triglyceride (TG),total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C).According to the level of thyroid hormone,the subjects were divided into subclinical hypothyroidism group (n =193) and euthyroid group (n =2146).Those in the euthyroid group were further divided into low TSH group (n =352,TSH ≥0.3 to ＜ 1.0 mU/L),moderate TSH group (n=916,TSH ≥1.0 to ≤1.9 mU/L) and highTSH group (n=944,TSH 1.9＜ to ≤4.8 mU/L).According to serum level of glucose,all the subjects were divided into normal glucose tolerance (NGT) group,impaired glucose regulation (IGR) group,and diabetes mellitus (DM) group. The relationship between thyroid function indexes and glucose was analyzed. Student' s t test or Analysis of Variance was used for data analysis. Results The level of OGTT 2-h glucose in the subclinical hypothyroidism group was significantly higher than that in the euthyroid group ( (8.3 ±4.4) vs (7.7 ±4.2) mmol/L,t =-2.163,P ＜0.05).The level of FT4 in the DM group was significantly higher than that in the IGR group and NGT group ( ( 16.8 ± 2.1 ),( 16.3 ± 2.1 ),and ( 16.2 ± 1.9 ) pmol/L,respectively ;F =10.515,P ＜0.01 ).The prevalence of subclinical hypothyroidism in the DM group and IGR group was significantly higher than that in the NGT group in females,and the prevalence of subclinical hypothyroidism in females was significantly higher than that in males. After adjusting for body mass index ( BMI ),waistline,blood pressure and lipids,the level of FPG was positively correlated with FT4 in the total population (β =2.748,P ＜0.01 ).For males,the level of FPG was positively correlated with FT4 (β =2.346,P ＜0.01 ).The level of OGTT 2-h glucose in females was correlated with FT4 (β =2.748,P ＜0.01 ).Within the normal range,the higher level of FT4 showed higher risk of diabetes (total population:odds ratio (OR) =1.142,95％ confidence interval (CI) 1.064 to 1.225,P＜0.01; female:OR=1.147,95％ CI1.024 to 1.284,P＜0.05; male:0R=1.142,95％ CI1.035 to 1.261,P＜0.01).There was no correlation between TSH or FT3 and diabetes.Conclusion The prevalence of subclinical hypothyroidism may be increased in female patients with IGR or DM.FT4 could be positively correlated to blood glucose,and higher level of FT4 might result in higher risk of diabetes.
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