甲状腺功能正常的非糖尿病人群甲状腺激素水平与胰岛素抵抗的关系

摘要

Objective To investigate the relationship between thyroid hormone level and insulin resistance among non-diabetic population with normal thyroid functions.Methods Relying on the REACTION Research initiated by Chinese Medical Association in 2011,totally 5428 individuals who met the research requirements were selected in Dalian.The following data were collected,including height,weight,blood pressure,OGTT,the levels of blood lipids,blood creatinine,blood uric acid,blood glucose,glycosylated hemoglobin,fasting insulin,thyroid function indicators,and HOMA-IR.The whole group was divided into two teams,team A with TSH levels lower than 2.5 mIU/L and team B with TSH levels higher than 2.5 mIU/L.The same items above between two teams were compared.The relationship between thyroid hormone level and insulin resistance was studied.Results Compared with team A,team B had lower levels of blood creatinine,blood uric acid and FT4 and higher levels of LDL,cholesterol, glycosylated hemoglobin,fasting insulin and HOMA-IR (P <0.05).There was a positive correlation between TSH level and HOMA-IR (r =0.145,P =0.000)and a positive correlation between FT3 level and HOMA-IR as well (r =0.040,P = 0.003 ),while there was a negative correlation between FT4 level and HOMA-IR (r = 0.017,P =0.000).Logistic regression analysis showed that gender,diastolic blood pressure,BMI,HDL,LDL,cholesterol, glycosylated hemoglobin,blood uric acid,TSH and FT4 were independently the risk factors to affect HOMA-IR (P <0.05),in which HDL and FT4 were protecting factors (P < 0.05 ).Conclusion There is a positive correlation between TSH level within normal ranges and insulin resistance of non-diabetic people,while there is a negative correlation between FT4 and insulin resistance.In addition,TSH and FT4 are the independent risk factors affecting insulin resistance.%目的 对甲状腺功能正常的非糖尿病人群中甲状腺激素水平与胰岛素抵抗关系进行横断面研究.方法 依托2011年由中华医学会发起的REACTION研究,选取大连地区符合标准的研究对象共5428例.以促甲状腺激素(TSH)2.5 mU/L为分界,分为低TSH组及高TSH组,测量两组身高、体重、血压,进行口服葡萄糖耐量(OGTT),检验血脂、血肌酐(SCr)、血尿酸(UA)、血糖、糖化血红蛋白(HbA1 c)、空腹胰岛素(FINS)、甲状腺功能,稳态模型评估胰岛素抵抗指数(HOMA-IR).研究甲状腺激素水平与胰岛素抵抗的相关性.结果 与低TSH组比较,高TSH组SCr、UA及游离甲状腺素(FT4)水平降低,低密度脂蛋白胆固醇(LDL-C)、胆固醇(TC)、HbA1 c、FINS及HOMA-IR增高(P<0.05).TSH、游离三碘甲状腺原氨酸(FT3)与HOMA-IR呈正相关(r=0.145、0.040,P<0.05).而FT4水平与HOMA-IR指数呈负相关(r=-0.071,P=0.000).回归分析显示性别、舒张压(DBP)、BMI、高密度脂蛋白胆固醇(HDL-C)、LDL-C、TC、HbA1 c、UA、TSH、FT4为影响HOMA-IR的独立危险因素(P<0.05).其中HDL-C及FT4为保护性因素(P<0.05).结论在正常范围内的TSH水平与非糖尿病人群的胰岛素抵抗呈正相关,FT4与胰岛素抵抗呈负相关,且TSH、FT4为影响胰岛素抵抗的独立危险因素.