摘要
目的探讨甲状腺功能正常的2型糖尿病(type2 diabete smellitus, T2DM)患者胰岛β细胞及α细胞分泌功能与血浆游离三碘甲状腺原氨酸(free triiodothyronine, FT3 )水平的相关性。方法选取我院2014年1月至2017年8月收治的264例T2DM患者作为研究对象,通过回顾性分析记录所有患者性别、年龄、疾病情况等一般资料以及甲状腺功能指标、糖尿病相关指标及生化指标水平,并根据FT3的血正常水平从高至低将其分为 A 组(5. 67 pmol/L < FT3 W6.47pmol/L) 40 例、B 组(4. 88pmol/L < FT3≤5. 67pmol/L) 66 例、C 组(4.07 pmol/L<FT3≤4. 88 pmol/L) 74 例和 D 组(3.28 pmol/L < FT3≤4. 07pmol/L) 84例,并比较分析4个组的患者之间临床资料的差异性以及其相关性。结果①4组患者在FT3和FT4水平的比较上具有差异,且A组FT4水平显著髙于B组、C组和D组(P<0.05);②4组患者ALT水平比较差异间具有统计学意义(P<0.05),且随着FT3水平的降低,ALT水平呈下降趋势;③4组患者在1h和2h时4组患者胰岛素水平比较差异间均具有统计学意义(P<0.05),且随着FT3的降低而均呈下降趋势;④4组患者在HOMA-β值比较差异间具有统计学意义,且随着FT3的降低,HOMA-β值呈下降趋势(P<0.05);⑤4组患者其空腹、餐后30 min、1h及3h时的胰高糖素水平比较差异间均具有统计学意义,且随着FT3水平的降低,其胰高糖素水平呈上升趋势(P<0.05);⑥经Spearman相关分析得胰岛β细胞功能与体质量指数、FT3及HDL-C呈正相关,而与TSH、TG、UA及HbAlc呈负相关(P<0.05);胰岛a细胞功能与HDL-C和FT3呈负相关,而与空腹血糖及HbAlc呈正相关(P<0.05);⑦采用多元逐步回归分析得体质量指数升高、FT3水平以及病程和年龄是影响胰岛β细胞功能的独立因素(P<0.05);而FT3、HDL-C和空腹胰高糖素是影响胰岛α细胞功能的独立因素(P<0.05)。结论在甲状腺功能正常的T2DM患者当中,FT3的表达水平与其胰岛β细胞和α细胞功能有着密切联系,且随着FT3水平的升高,可进一步保护胰岛β细胞的分泌功能。
Objective To investigate the correlation between the secretory function of islet (5- cells and α-cells and blood free triiodothyronine ( FT3 ) levels in euthyroid patients with type 2 diabetes mellitus ( T2DM). Methods A total of 264 patients with T2DM who were admitted to our hospital from January 2014 to August 2017 were enrolled. The general information such as gender, age, disease status, and thyroid function indicators, diabetes-related indicators, and biochemical indicators were obtained and retrospectively analyzed. According to the normal blood levels of FT3 , patients were divided into four groups, including 40 cases in group A (5. 67 pmol/L < FT3 ≤6. 47 pmol/L, 66 cases in group B (4. 88 pmol/L < FT3 ≤ 5. 67 pmol/L), 74 cases in group C (4. 07 pmol/L < FT3 ≤ 4. 88 pmol/L) and 84 cases in group D (3. 28 pmo1/L < FT3 ≤4. 07 pmol/L).The differences and their correlation in the above clinical data between the four groups were compared and analyzed. Results ① There was significant difference in the FT3 and FT4 levels among the 4 groups, and the FT4 levels in group A were significantly higher than those in groups B, C, and D ( P < 0. 05 );② The ALT levels were statistically significantly different between the four groups (P < 0. 05), and the ALT levels tended to reduce with the decrease of FT3 levels;③ significant difference was found in the insulin levels between the four groups at 1 h and 2 h ( P < 0. 05 ), and the insulin levels were downregulated with the decrease of FT3 levels;④ there was significant difference in the HOMA-β values between the four groups ( P < 0. 05 ), and the values showed a downward trend with the decrease of FT3 levels;⑤ the glucagon levels between the four groups at fasting, 30 min, 1 h, and 3 h were statistically significantly different (P <0. 05), and the levels showed a upward trend with the decrease of FT3 levels;(6) Spearman correlation analysis showed that islet 0 cell function was positively correlated with body mass index, FT3 and HDL-C, but negatively with TSH, TG, UA and HbAl (P < 0. 05 );Islet a cell function was negatively correlated with HDL-C and FT3 , but positively with fasting blood glucose and HbAlc (P < 0. 05).⑦ Multiple stepwise regression analysis showed that elevated body mass index, FT3 level, and duration and age were independent factors that affected islet β-cell function ( P < 0. 05 );FT3 , HDLC, and fasting glucagon independently affected isletα-cell function ( P < 0. 05 ). Conclusion In euthyroid patients with T2DM, the expression level of FT3 is closely related to the functions of pancreatic β-cells and α-cells. Moreover, with the increase of FT3 levels, the secretion of pancreatic p-cells can be further protected.
作者
胡亚芬
李洁超
吴震宇
张费锋
马远方
李香波
薛长春
HU Yafen;LI Jiechao;WU Zhenyu;ZHANG Yunfeng;MA Yuanfang;LI Xiangbo;XUE Changchun(The Capital Medical University Hospital of Daxing Teaching ( The People' s Hospital of Daxing District, Beijing), Beijing, 102600, China)
出处
《医学分子生物学杂志》
CAS
2019年第3期263-268,共6页
Journal of Medical Molecular Biology
