摘要
目的探讨糖尿病患者血清甲状腺激素水平的变化及临床意义。方法418例2型糖尿病患者,入院后行24h动态血糖监测,计算平均血糖(MBG),测定空腹血糖(FPG)和血清C肽(FCP)、餐后2h血糖(2hPG)和血清C肽(2hPCP)、糖化血红蛋白(HbAlc)、糖化血清蛋白(GA)及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)、反三碘甲状腺原氨酸(rT3)水平。按不同FPG水平分为FPG>13.47mmol/L、>8.81且≤13.47mmol/L和≤8.81mmol/L组,按不同HbAlc水平分为<7%、≥7%且<10%、≥10%且<13%和≥13%组,比较各组间FT3、FT4、TSH、和rT3水平的差异。并分析影响甲状腺激素水平的主要因素。结果FPG>13.47mmol/L、>8.81且≤13.47mmol/L组的FT3和rT3显著低于FPG≤8.81mmol/L组(P值分别<0.01、0.05),FPG>13.47mmol/L组的TSH显著低于FPG≤8.81mmol/L组(P<0.01)。HbAlc≥7%且<10%、≥10%且<13%和≥13%组的FT3和TSH显著低于HbAlc<7%组(P值分别<0.01、0.05)。FPG、MBG、HbAlc、AGE、GA的变化与FT3水平呈线性负相关(P<0.05),与rT3水平呈线性正相关(P<0.05)。多元逐步回归分析发现,年龄是影响FT3和rT3变化的独立因素(OR=-0.061、0.004,P=0.00、0.001),FPG也是影响FT3和rT3变化的独立因素(OR=-0.012、0.19,P=0.00、0.001)。结论甲状腺激素水平对糖尿病患者糖代谢的评估具有重要的临床意义。
Objective To investigate the variation of serum thyroid hormone in diabetes patients and its clinical significance. Methods A total of 418 diabetic patients were enrolled in this study. The mean blood glucose （MBG）, hemoglobin A,c （HbA, c）, glycated albumin （GA）, and thyroid hormones free tri-iodothyronine （FT3）, free thyroxine （FT4）, revese-tri-iodothyronine （ rT3 ）, and thyroid stimulating hormone （TSH） were measured in each patient. The patients were divided into 3 groups according to the level of FPG： FPG〉 13.47 mmol/L, 8.81- 13.47 mmol/L and ≤ 8.81 mmol/L groups. They were also divided into 4 groups according to the levels of HbA1c：〈7%, 7%- 10%, 10% - 13%, and ≥13% groups. The levels of FT3, FT4, TSH and rT3were compared between different groups. The main influencing factors of the serum thyroid hormone level were analyzed. Results The FT3 and rT3 levels in FPG〉 13.47 mmol/L and 8.81-13.47 mmol/L groups were significantly lower than those in the FPG≤8.81 mmol/L group （P〈0.01 or 0.05）. The TSH level in the FPG〉 13.47 mmol/Lg groups was significantly lower than that of the FPG≤8.81 mmol/L group （P〈0.01）. The FT3 and TSH levels in HbA1c 7% - 10%, 10% - 13% and ≥ 13% groups were significantly lower than that of the HbA1c〈7% group （P〈0.01 or 0.05）. FPG, MBG, HbA1c, AGE and GA were negatively correlated with FT3 level （P〈0.05） and positively correlated with rT3 level （P〈 0.05）. We also found that age （OR = -0. 061, 0.004, P=0.00, 0.001） and FPG （OR = -0.012, 0.19, P=0.00, 0.001） were the independent factors of FT3 and rT3, Conclusion The levels of thyroid hormone is of great clinical significance for assessment of the glucose metabolism in diabetic patients. （Shanghai Med J, 2009, 32： 424-427）
出处
《上海医学》
CAS
CSCD
北大核心
2009年第5期424-427,共4页
Shanghai Medical Journal
