代谢综合征患者胰岛素抵抗程度与甲状腺结节的相关性研究

摘要

Objective To explore the risk factors of thyroid nodules in patients with metabolic syndrome,and to in-vestigate the correlation between insulin resistance and thyroid nodules.Methods 185 cases with metabolic syndrome and 185 healthy candidates were enrolled and the prevalence of thyroid nodules was compared.According to ultrasonic examination,the patients with metabolic syndrome were divided into two groups:thyroid nodules group and control group.The gender,age,height,body weight,SBP,DBP,TG,TC,LDL-C,HDL-C,FPG,FINS,TSH,BMI and HOMA-IR were measured and compared between 2 groups.Logistic regression was used to explore the risk factors of thyroid nodules.The morbidity of thyroid nodules was compared in hierarchical HOMA-IR.Results The prevalence of thyroid nodules was 64.32% in metabolic syndrome,with 54.02% and 73.47% in men and women.These were significantly different to those in healthy individuals (47.57%,39.08% and 55.10%,respectively;P < 0.05).There were signifi-cant differences in gender,age,BMI,TG,SBP,FPG,FINS,HOMA-IR and TSH between thyroid nodules group and control group (P < 0.05).The logistic regression analysis showed that gender,BMI and HOMA-IR were correlated with thyroid nodules (P < 0.05).The prevalence of thyroid nodules increased with increasing HMOA-IR,and the difference was statistically significant between HOMA-IR > 2.0 and HOMA-IR < 2.0.Conclusion Female,higher BMI and HOMA-IR are risk factors of thyroid nodules.The prevalence of thyroid nodules increases with HOMA-IR. More attention should be paid for screening of thyroid nodules in patients with metabolic syndrome,especially in HO-MA-IR>2.0.%目的：探讨代谢综合征患者并发甲状腺结节的危险因素，以及胰岛素抵抗程度与甲状腺结节患病率之间的关系。方法选取2014年1月至2015年10月期间于我院就诊的代谢综合征患者185例，根据超声检查结果分为甲状腺结节组和非甲状腺结节组。同时选择185例健康查体者作为对照。所有患者行甲状腺超声检查，比较代谢综合征患者与健康对照甲状腺结节患病率的差异。测量并记录代谢综合征患者的性别、年龄、身高、体重、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、空腹血糖（FPG）、空腹胰岛素（FINS）、促甲状腺激素（TSH），计算体质量指数（BMI）、胰岛素抵抗指数（HOMA-IR）。比较甲状腺结节组和非结节组上述指标的差异，应用 logistic 回归分析筛选甲状腺结节的危险因素，并比较不同胰岛素抵抗指数下甲状腺结节患病率的差异。结果代谢综合征患者的甲状腺结节患病率为64．32％，男女患病率分别为54．02％和73．47％，差异有统计学意义（χ2＝7．595，P ＝0．006）。同期健康体检者的甲状腺结节总患病率为47．57％，男女患病率分别为39．08％和55．10％。代谢综合征患者的甲状腺结节患病率明显高于健康对照者（总体χ2＝10．538，P ＝0．001；男χ2＝3．904，P ＝0．048；女χ2＝7．200，P ＝0．007）。甲状腺结节组与非结节组的性别、年龄、BMI、TG、SBP、FPG、FINS、HOMA-IR、TSH 水平的差异有统计学意义（P ＜0．05），而 DBP、TC、LDL-C、HDL-C 的差异无统计学意义（P ＞0．05）。logistic 回归分析显示，性别、BMI 及 HOMA-IR 与甲状腺结节相关（P ＜0．05）。按＜1．0、1．0-2．0、2．0-3．0、3．0-4．0和＞4．0将 HOMA-IR 分为5组，甲状腺结节患病率分别为33．33％、48．57％、65.23％、78．13％和88．09％，HOMA-IR 在2．0以上及2．0以下时差异有统计学意义（P ＜0．05）。结论女性、高体质量指数、胰岛素抵抗指数升高是甲状腺结节的危险因素；随着胰岛素抵抗指数的升高，甲状腺结节患病率也不断升高，临床上应重视对代谢综合征患者（尤其是胰岛素抵抗指数＞2．0）进行甲状腺结节的筛查。