CAJ | 학술논문

目的探讨甲状腺功能亢进症（简称甲亢）患者血清抵抗素水平与血糖、血脂、甲状腺激素(TH)的关系。方法甲亢组50例，来源于2008、2009年就诊于哈医大二院内分泌科患者，均为新确诊尚未服药病例;以同时间到医院体检的40例健康者为对照组,两组均排除糖尿病、肥胖、高血压、高血脂。ELISA法测定血清抵抗素水平；化学发光法测定空腹胰岛素、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素(FT4)、促甲状腺激素(TSH)；葡萄糖氧化酶-过氧化物酶(GOD-PAP)法测定空腹血糖;胆固醇氧化酶法测定总胆固醇(T-CH)；磷酸甘油氧化酶(GPO)法测定甘油三酯(TG)；均相酶比色法测定高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。同时测定身高、体重、腰围、臀围，计算体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)。组间比较采用t检验，相关分析采用Pearson相关检验，用多元逐步回归方法比较抵抗素与血糖、血脂、TH的关系。结果甲亢组血糖[(5.2±0.7)mmol/L]、抵抗素[(132.1±41.3)μg/L]、FT3[(19.8±8.7) pmol/L]、FT4[(54.1±29.6)pmol/L]、胰岛素[(7.9±2.8)mU/L]、胰岛素抵抗指数[(2.3±1.0)]明显高于对照组[(4.7±0.5)mmol/L，(65.1±5.9)μg/L、(4.1±0.6)pmol/L、( 14.3±2.2)pmol/L、(6.4±2.7)mU/L、(1.5±1.2)；t值分别为4.64、10.17、11.42、8.49、4.48、9.42,P＜ 0.01或＜0.05]。甲亢组T-CH[(3.7±0.8)mol/L]、LDL-C[( 1.8±0.6)mol/L]、TSH[(0.01±0.01 )mU/L]明显低于对照组[(4.6±0.7) mol/L、(2.3±0.7)mol/L、( 1.80±0.90)mU/L;t值分别为5.30、3.33、14.48，P均＜0.01）]。相关分析显示，甲亢组抵抗素与FT3、FT4、HOMA-IR呈正相关(r=0.719、0.790、0.396，P＜0.01或＜0.05)，与T-CH、LDL负相关(r=-0.364、- 0.519，P＜0.05或＜0.01)。多元逐步回归显示，甲亢组抵抗素与FT3、FT4、HOMA-IR正相关（r=0.756，P均＜0.01）。结论抵抗素水平的调节受甲状腺激素影响，甲亢患者血抵抗素可能与胰岛素抵抗及糖脂代谢紊乱有关。目的探討甲狀腺功能亢進癥（簡稱甲亢）患者血清牴抗素水平與血糖、血脂、甲狀腺激素(TH)的關繫。方法甲亢組50例，來源于2008、2009年就診于哈醫大二院內分泌科患者，均為新確診尚未服藥病例;以同時間到醫院體檢的40例健康者為對照組,兩組均排除糖尿病、肥胖、高血壓、高血脂。ELISA法測定血清牴抗素水平；化學髮光法測定空腹胰島素、遊離三碘甲狀腺原氨痠（FT3）、遊離甲狀腺素(FT4)、促甲狀腺激素(TSH)；葡萄糖氧化酶-過氧化物酶(GOD-PAP)法測定空腹血糖;膽固醇氧化酶法測定總膽固醇(T-CH)；燐痠甘油氧化酶(GPO)法測定甘油三酯(TG)；均相酶比色法測定高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)。同時測定身高、體重、腰圍、臀圍，計算體重指數(BMI)、胰島素牴抗指數(HOMA-IR)。組間比較採用t檢驗，相關分析採用Pearson相關檢驗，用多元逐步迴歸方法比較牴抗素與血糖、血脂、TH的關繫。結果甲亢組血糖[(5.2±0.7)mmol/L]、牴抗素[(132.1±41.3)μg/L]、FT3[(19.8±8.7) pmol/L]、FT4[(54.1±29.6)pmol/L]、胰島素[(7.9±2.8)mU/L]、胰島素牴抗指數[(2.3±1.0)]明顯高于對照組[(4.7±0.5)mmol/L，(65.1±5.9)μg/L、(4.1±0.6)pmol/L、( 14.3±2.2)pmol/L、(6.4±2.7)mU/L、(1.5±1.2)；t值分彆為4.64、10.17、11.42、8.49、4.48、9.42,P＜ 0.01或＜0.05]。甲亢組T-CH[(3.7±0.8)mol/L]、LDL-C[( 1.8±0.6)mol/L]、TSH[(0.01±0.01 )mU/L]明顯低于對照組[(4.6±0.7) mol/L、(2.3±0.7)mol/L、( 1.80±0.90)mU/L;t值分彆為5.30、3.33、14.48，P均＜0.01）]。相關分析顯示，甲亢組牴抗素與FT3、FT4、HOMA-IR呈正相關(r=0.719、0.790、0.396，P＜0.01或＜0.05)，與T-CH、LDL負相關(r=-0.364、- 0.519，P＜0.05或＜0.01)。多元逐步迴歸顯示，甲亢組牴抗素與FT3、FT4、HOMA-IR正相關（r=0.756，P均＜0.01）。結論牴抗素水平的調節受甲狀腺激素影響，甲亢患者血牴抗素可能與胰島素牴抗及糖脂代謝紊亂有關。
목적 탐토갑상선공능항진증（간칭갑항）환자혈청저항소수평여혈당、혈지、갑상선격소(TH)적관계。방법 갑항조50례，래원우2008、2009년취진우합의대이원내분비과환자，균위신학진상미복약병례;이동시간도의원체검적40례건강자위대조조,량조균배제당뇨병、비반、고혈압、고혈지。ELISA법측정혈청저항소수평；화학발광법측정공복이도소、유리삼전갑상선원안산（FT3）、유리갑상선소(FT4)、촉갑상선격소(TSH)；포도당양화매-과양화물매(GOD-PAP)법측정공복혈당;담고순양화매법측정총담고순(T-CH)；린산감유양화매(GPO)법측정감유삼지(TG)；균상매비색법측정고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)。동시측정신고、체중、요위、둔위，계산체중지수(BMI)、이도소저항지수(HOMA-IR)。조간비교채용t검험，상관분석채용Pearson상관검험，용다원축보회귀방법비교저항소여혈당、혈지、TH적관계。결과 갑항조혈당[(5.2±0.7)mmol/L]、저항소[(132.1±41.3)μg/L]、FT3[(19.8±8.7) pmol/L]、FT4[(54.1±29.6)pmol/L]、이도소[(7.9±2.8)mU/L]、이도소저항지수[(2.3±1.0)]명현고우대조조[(4.7±0.5)mmol/L，(65.1±5.9)μg/L、(4.1±0.6)pmol/L、( 14.3±2.2)pmol/L、(6.4±2.7)mU/L、(1.5±1.2)；t치분별위4.64、10.17、11.42、8.49、4.48、9.42,P＜ 0.01혹＜0.05]。갑항조T-CH[(3.7±0.8)mol/L]、LDL-C[( 1.8±0.6)mol/L]、TSH[(0.01±0.01 )mU/L]명현저우대조조[(4.6±0.7) mol/L、(2.3±0.7)mol/L、( 1.80±0.90)mU/L;t치분별위5.30、3.33、14.48，P균＜0.01）]。상관분석현시，갑항조저항소여FT3、FT4、HOMA-IR정정상관(r=0.719、0.790、0.396，P＜0.01혹＜0.05)，여T-CH、LDL부상관(r=-0.364、- 0.519，P＜0.05혹＜0.01)。다원축보회귀현시，갑항조저항소여FT3、FT4、HOMA-IR정상관（r=0.756，P균＜0.01）。결론 저항소수평적조절수갑상선격소영향，갑항환자혈저항소가능여이도소저항급당지대사문란유관。
Objective To undertake a controlled, prospective study to investigate the relationship between serum resistin level and blood sugar, blood lipids and thyroid hormone in patients with hyperthyroidism. Methods Clinical data of 50 patients with hyperthyriodism were collected from 2008 to 2009 in department of endocrinology the Second Hospital of Harbin Medical University. All patients were newly diagnosed cases that received no medication. At the same time, 40 healthy persons underwent physical examination in the hospital were taken as control group. Diabetes, obesity, hypertension, and high cholesterol were excluded from the two groups. Serum resistin level was determined using ELISA method. Chemiluminescence was used to check the levels of fasting insulin, free triiodothyronine (FT3), free thyroxin (FT4), and thyroid stimulating hormone (TSH). Glucose oxidase method determination-peroxidase-anti-peroxidase(GOD-PAP) was used to check the levels of fasting blood-glucose.Cholesterol oxidase method was used to check the levels of total cholesterol(T-CH). Glycerol-phosphate oxidase was used to check the levels of triglyceride(TG). Enzymes colorimetric method was used to check high density level of lipoprotein cholesterol(HDL-C) and low density level of lipoprotein cholesterol (LDL-C), and the height, weight,waist circumference, and hip circumference were measured. Body mass index (BMI) and insulin resistance index (HOMA-IR) were calculated. Groups were compared using t test and correlation analysis using Pearson correlation test, and the relationship between serum resistin level and blood sugar, blood lipids and thyroid hormone were analyzed using multiple linear stepwise regression analysis method. Results Serum glucose[(5.2 ± 0.7)mmol/L],resistin concentrations[(132.1 ± 41.3)μg/L], FT3[(19.8 ± 8.7) pmol/L], FT4[(54.1± 29.6)pmol/L], fasting insulin levels[(7.9 ± 2.8)mU/L] and HOMA-IR(2.3 ± 1.0) were significantly higher compared with controls group [(4.7 ± 0.5)mmol/L, (65.1 ± 5.9)μg/L, (4.1 ± 0.6)pmol/L, (14.3 ± 2.2)pmol/L, (6.4 ± 2.7)mU/L, (1.5 ±1.2); t =4.64, 10.17, 11.42, 8.49, 4.48, 9.42, P＜ 0.01 or ＜ 0.05)]. T-CH[(3.7 ± 0.8) mol/L], LDL-C[(1.8 ±0.6)mol/L], TSH[(0.01 ± 0.01 )mU/L] were significantly lower compared with controls group[(4.6 ± 0.7)mol/L,(2.3 ± 0.7)mol/L, (1.80 ± 0.90)mU/L; t =5.30, 3.33, 14.48; all P＜ 0.01)]. Pearson correlation analysis showed that resistin and FT3, FT4 and HOMA-IR was positively correlated, respectively (r =0.719, 0.790, 0.396, P ＜ 0.01or＜ 0.05), resistin and T-CH and LDL was negatively correlated, respectively(r =- 0.364, - 0.519, P ＜ 0.05or ＜ 0.01). Multiple linear regression analysisshowed that resistin and FT3, FT4, and HOMA-IR was positively correlated, respeetively(r =0.756, P ＜ 0.01 ). Conclusion Resistin and FT3 and FT4 are related. Resistin might play important roles in insulin resistance and glucose and lipid metabolism disorders in patients with hyperthyriodism.