CAJ | 학술논문

目的：血清甲状腺激素生理范围内的波动可能与胰岛素的敏感性存在相关性。本研究探讨在甲状腺功能正常的老年2型糖尿病（type 2 diabetes mellitus， T2DM）患者中甲状腺激素生理范围内的变化与胰岛素敏感性的关系。方法选取2013年9月至2014年5月在南京市市级机关医院内分泌科就诊的老年T2 DM患者200例及150例正常对照者分别纳入T2DM组和对照组。所有研究对象均进行口服75 g葡萄糖耐量试验，收集血样本，并对入选者进行问卷调查、体格检查及代谢相关指标的测定。使用化学发光法测定胰岛素、促甲状腺激素（ thyroid stimulating hormone ， TSH）、游离三碘甲腺原氨酸（ FT3）和游离甲状腺素（ FT4）。按照FT3水平三分位数将研究对象分成3组，比较各组间Matsuda指数差异及相关性。结果老年T2DM组患者HOMA-IR显著高于对照组[（5．18±3．22） vs （2．35±1．82）]，而Matsuda指数均显著低于对照组[（2．79±1．32） vs （5．81±3．11）]（P＜0．05）；老年T2DM组FT3水平低于对照组[（4．05±0．27）pmol／L vs （4．61±0．5）pmol／L）]，差异有统计学意义（P＜0．05）；老年T2DM组TSH水平高于对照组[（2．75±1．07）IU／mL vs （2．28±0．89）IU／mL]，差异有统计学意义（P＜0．05）；FT3高水平组Matsuda 指数（4．71±2．64）分别高于FT3中水平组（3．98±2．31）和低水平组（3．89±1．98），差异有统计学意义（P＝0．04）；FT3水平与Matsuda指数呈正相关，与HOMA-IR呈负相关（P＜0．05）。多元逐步回归分析进一步提示FT3水平与Matsuda指数密切相关。结论甲状腺激素尤其是FT3水平与胰岛素抵抗密切相关，FT3可能参与T2DM的发生发展。
목적：혈청갑상선격소생리범위내적파동가능여이도소적민감성존재상관성。본연구탐토재갑상선공능정상적노년2형당뇨병（type 2 diabetes mellitus， T2DM）환자중갑상선격소생리범위내적변화여이도소민감성적관계。방법선취2013년9월지2014년5월재남경시시급궤관의원내분비과취진적노년T2 DM환자200례급150례정상대조자분별납입T2DM조화대조조。소유연구대상균진행구복75 g포도당내량시험，수집혈양본，병대입선자진행문권조사、체격검사급대사상관지표적측정。사용화학발광법측정이도소、촉갑상선격소（ thyroid stimulating hormone ， TSH）、유리삼전갑선원안산（ FT3）화유리갑상선소（ FT4）。안조FT3수평삼분위수장연구대상분성3조，비교각조간Matsuda지수차이급상관성。결과노년T2DM조환자HOMA-IR현저고우대조조[（5．18±3．22） vs （2．35±1．82）]，이Matsuda지수균현저저우대조조[（2．79±1．32） vs （5．81±3．11）]（P＜0．05）；노년T2DM조FT3수평저우대조조[（4．05±0．27）pmol／L vs （4．61±0．5）pmol／L）]，차이유통계학의의（P＜0．05）；노년T2DM조TSH수평고우대조조[（2．75±1．07）IU／mL vs （2．28±0．89）IU／mL]，차이유통계학의의（P＜0．05）；FT3고수평조Matsuda 지수（4．71±2．64）분별고우FT3중수평조（3．98±2．31）화저수평조（3．89±1．98），차이유통계학의의（P＝0．04）；FT3수평여Matsuda지수정정상관，여HOMA-IR정부상관（P＜0．05）。다원축보회귀분석진일보제시FT3수평여Matsuda지수밀절상관。결론갑상선격소우기시FT3수평여이도소저항밀절상관，FT3가능삼여T2DM적발생발전。
Objective The variation of serum thyroid hormones within the euthyroid range may be associated with insulin sensitivity.The study was to investigate whether the variation of thyroid hormones within the euthyroid range could influence insulin sensitivity in elderly patients with type 2 diabetes mellitus (T2DM). Methods 200 elderly inpatients and outpatients with type 2 diabetes were collected from September 2013 to May 2014 in our hospital for T2DM group.150 normal controls with normal glucose metabolism were taken as the control group.Blood samples were collected after 75g oral glucose tolerance test(OGTT) on all the re-search objects.Questionaire survey, physical examination and related metabolic index test were also done on them .Chemilumines-cence method were applied to detect their insulin, thyroid stimulating hormone(TSH), FT3 and FT4. Results FT3 levels were significantly lower in T2DM group than in control group[(4.05 ±0.27 )pmol/L vs (4.61 ±0.5)pmol/L), P<0.05].TSH levels were significantly higher in T2DM group than in control group[(2.75 ±1.07) IU/mL vs (2.28 ±0.89) IU/mL, P<0.05], while there was no significant difference as to FT4 levels between these two groups.All subjects were divided into three groups according to the tertiles of FT3 level, Matsuda index of high FT3 level group were significantly higher in comparison to middle and low FT3 level groups, while there was no significant difference as to HOMA-IR in the three groups.FT3 levels were negatively correlated with HO-MA-IR and positively correlated with Matsuda index .After stepwise regression analysis, there was significant positive association be-tween FT3 and Matsuda index. Conclusion Thyroid hormone especially FT3 is significantly associated with insulin resistance .FT3 may participate in the development of type 2 diabetes, which pro-vides a new treatment for T2DM.