摘要
目的 对甲状腺功能正常的非糖尿病人群中甲状腺功能与糖化血红蛋白（HbA1c）的关系进行横断面研究.方法2012年1月至2016年12月从大连市中心医院内分泌科选取甲状腺功能正常的非糖尿病人群共5428例.测量身高、体重、血压、促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、空腹血糖、口服葡萄糖耐量试验（OGTT）2 h血糖、HbA1c、血肌酐、血尿酸、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FINS）,计算稳态模型胰岛素抵抗指数（HOMA-IR）.以TSH 2.5 mU/L为分界,将患者分为低TSH组（A组,3691例）及高TSH组（B组,1715例）,比较两组间上述指标,分析甲状腺功能与HbA1c的相关性.应用Spearman相关分析及Logistic多元线性回归进行统计学分析.结果 与A组比较,B组血肌酐、血尿酸及FT4水平更低（均P〈0.05）,LDL-C、TC、TG、HbA1c、FINS水平及HOMA-IR值更高（均P〈0.05）.Spearman相关分析显示,TSH与HbA1c呈正相关（r=0.038,P=0.005）,而FT3（r=0.022,P=0.101）、FT4（r=0.002,P=0.861）与HbA1c不相关.Logistic多元线性回归分析显示,年龄、女性、BMI、TC、空腹血糖、OGTT 2 h血糖、血尿酸、TSH为影响HbA1c的独立危险因素（OR值分别为1.029、1.845、1.021、1.194、2.853、1.106、1.002、1.147,均P〈0.05）;而收缩压具有轻微的保护作用（OR=0.096, P〈0.05）.结论 在甲状腺功能正常的非糖尿病人群中,高TSH水平与HbA1c呈正相关,为影响HbA1c的独立危险因素.该结果提示,在正常范围内TSH升高仍会增加糖代谢异常的风险.
Objective The correlation between thyroid function and glycated hemoglobin（HbA1c）in non-diabetic populations with normal thyroid function was studied in cross-sectional way.Methods Totally 5 428 non-diabetic individuals with normal thyroid function in Dalian were enrolled in Department of Endocrinology of Dalian Municipal Central Hospital from January 2012 to December 2016. The following aspects were examined, including height, weight, blood pressure, thyroid stimulating hormone （TSH）, free thyroxine （FT4）, free triiodothyronine （FT3）, fasting plasma glucose （FPG）, oral glucose tolerance test （OGTT） 2 h glucose, HbA1c, blood creatinine, blood uric acid, total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein-cholesterol （HDL-C）, low-density lipoprotein-cholesterol （LDL-C） and fasting insulin. Homeostasis model assessment insulin resistance （HOMA-IR） was calculated. The population was divided into two subgroups, group A （n=3 691） with serum TSH〈2.5 mU/L and group B （n=1 715） with serum TSH≥2.5 mU/L.The correlation between thyroid function and HbA1cwas investigated with Spearman correlation analysis and Logistic regression analysis. Results Compared with group A,the levels of blood creatinine,blood uric acid and FT4were lower and the levels of LDL-C,TC,TG,HbA1c,fasting insulin and HOMA-IR were higher in group B （ all P〈0.05 ）. TSH was positively correlated with HbA1c（r=0.038,P=0.005）. However, HbA1cwas not related with FT3（r=0.022,P=0.101） and FT4（r=0.002,P=0.861）. With Logistic regression analysis, it was showed that age, gender, body mass index, TC, FPG, OGTT 2 h blood glucose, blood uric acid and TSH were individually risk factors of glycosylated hemoglobin （OR=1.029, 1.845, 1.021, 1.194, 2.853, 1.106, 1.002, 1.147,respectively, all P〈0.05）. But the systolic blood pressure was an protective factor（OR=0.096,P〈0.05）.Conclusion High TSH level within normal thyroid function was positively correlated with glycosylated hemoglobin in non-diabetic patients and also was an independent risk factor of HbA1c.It is indicated that the increasing of TSH even within normal range may increase the risk of abnormal glucose metabolism.
出处
《中华糖尿病杂志》
CAS
CSCD
2017年第12期774-778,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
