不同糖代谢状态人群血清游离脂肪酸与甲状腺功能状态的相关性研究

发布时间：2018-04-03 04:24

  本文选题：促甲状腺激素(TSH)　切入点：游离脂肪酸(FFA)　出处：《河北医科大学》2015年硕士论文

【摘要】：目的:随着我国经济的快速发展,居民的膳食结构发生了很大的改变,脂肪类食物的摄入超标,糖脂代谢异常成为普遍现象。我们前期的研究发现在糖代谢异常的患者血中游离脂肪酸升高,特别是饱和脂肪酸的增多更加明显。游离脂肪酸的增多对促进胰岛素抵抗的形成起到了重要作用,深入研究游离脂肪酸增加的因素,对改善糖代谢异常和胰岛素抵抗有重要意义。近年来对甲状腺功能的研究显示,甲状腺激素的水平可以影响脂代谢的调节。甲状腺功能减退(甲减)患者出现血胆固醇水平的升高等血脂异常已被大家所认识,单纯亚临床甲减对血脂影响的研究也已经表明,常伴有总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)增高及高密度脂蛋白胆固醇(high-densitylipoprotein cholesterol,HDL-C)降低。近年的研究表明,在甲状腺功能正常的人群中也存在甲状腺激素水平与血脂水平的相关性。但是,甲状腺激素水平与血游离脂肪酸的水平的相关性研究不多,特别是在糖代谢异常状态人群甲状腺激素水平与血游离脂肪酸的增多的相关性了解甚少。本研究选取健康人群、糖耐量减低人群和糖尿病人群,测定血脂、游离脂肪酸(FFA)、甲状腺激素、糖化血红蛋白、空腹胰岛素、胰岛素抵抗指数、分析FFA与TSH之间的相关性、FFA与胰岛素抵抗的相关性以及TSH与胆固醇的相关性。探讨不同糖代谢状态人群血清游离脂肪酸与甲状腺功能状态的相关性。方法:采用75g葡萄糖耐量实验(OGTT)分为糖耐量正常者67例(A组)、糖耐量异常者55例(B组)、2型糖尿病患者68例(C组),空腹的血糖受损(IFG)者归为IGT组。2型糖尿病诊断标准符合1999年WHO关于糖尿病诊断标准。胰岛素抵抗指数HOMA-IR=空腹血糖(FBG,mmol/L)×空腹胰岛素水平(FIns,m IU/l)/22.5。应用Elisa试剂盒检测游离脂肪酸;应用全自动生化仪检测血糖、血脂等指标;血清胰岛素、甲状腺激素测定应用电化学发光法;糖化血红蛋白应用高压液相色谱法。用SPSS18.0软件分析数据。结果:1各组患者糖尿病相关指标的变化糖化血红蛋白在A组、B组、C组之间存在差异,A组与C组之间差异有统计学意义(P0.05)。FINS:A组8.39±6.43μU/ml、B组11.87±5.96μU/ml、C组11.93±12.67μU/ml。各组空腹胰岛素逐渐增加,A组与B组、C组比较均有统计学差异(P0.05),但B组与C组无统计学差异。HOMA-IR:A组2.00±1.84、B组2.99±1.55、C组4.45±5.05,A组与B组之间及A组与C组之间均有明显差异。HOMA-β:A组96.21±53.60、B组126.60±111.62、C组66.92±82.42,A组与B组之间差异明显(P0.05),C组数值明显降低,与A组、B组之间明显差异(P0.05)。2各组患者血脂相关指标的变化FFA:A组54.21±19.18 pg/ml、B组71.28±42.55 pg/ml、C组71.39±26.82 pg/ml,A组与B组、C组出现明显差异(P0.05),但糖尿病组与糖耐量减低组之间无明显差异(P0.05)。总胆固醇:A组4.68±0.79mmol/l、B组5.05±0.89 mmol/l、C组4.81±1.07 mmol/l.A组与B组差异有统计学意义,但B组与C组之间差异无统计学意义。高密度脂蛋白胆固醇:A组1.52±0.39 mmol/l、B组1.30±0.30 mmol/l、C组1.02±0.26mmol/l。低密度脂蛋白胆固醇:A组2.53±0.74 mmol/l、B组3.61±0.82mmol/l、C组3.16±1.01 mmol/l,A组与B组差异有统计学意义(P0.05)。3各组甲状腺功能相关激素的变化TSH:A组2.05±0.88μIU/ml、B组2.48±1.54μIU/ml、C组1.76±0.85μIU/ml,A组与B组差异有统计学意义(P0.05)。TT3:A组1.80±0.36 nmol/l、B组1.95±0.89 nmol/l、C组1.67±0.30 nmol/l,A组与B组差异无统计学意义(P0.05),C组与B组差异有统计学意义(P0.05)。TT4:A组104.47±23.92 nmol/l、B组109.21±24.20 nmol/l、C组92.85±31.62nmol/l,A组与B组差异无统计学意义(P0.05),C组与A、B组差异有统计学意义(P0.05)。4游离脂肪酸与促甲状腺激素相关性不同糖耐量状态下,血清游离脂肪酸与促甲状腺激素呈正相关,r=0.671,P0.05。同时,游离脂肪酸与高密度脂蛋白负相关,r=-0.141,P0.05;游离脂肪酸与低密度脂蛋白正相关,r=0.157,P0.05。血促甲状腺激素与糖化血红蛋白负相关,r=-0.181,P0.05。促甲状腺激素与总胆固醇正相关,r=0.172,P0.05。结论:1糖耐量减低人群存在游离脂肪酸的升高。2糖耐量减低人群血清游离脂肪酸的升高与促甲状腺激素的水平有关。
[Abstract]:Objective: with the rapid development of China's economy, great changes of dietary structure of residents, fat food intake exceed the standard, abnormal Glucolipids metabolism has become a common phenomenon. Our previous study found that free fatty acids in patients with abnormal blood glucose metabolism increased, especially saturated fatty acid free fat increased more obvious. Acid increased to an important role in promoting the formation of insulin resistance, in-depth study of factors of free fatty acids increased, to improve glucose metabolism and insulin resistance have important significance. Study on thyroid function in recent years, the level of thyroid hormone can affect lipid metabolism. Hypothyroidism (hypothyroidism) patients blood cholesterol levels and dyslipidemia has been recognized. Study on the effect of subclinical hypothyroidism on serum lipids alone has also shown, often accompanied by total cholesterol ( Total cholesterol, TC), low density lipoprotein cholesterol (low-density lipoprotein, cholesterol, LDL-C) and increased high density lipoprotein cholesterol (high-densitylipoprotein cholesterol, HDL-C) decreased. Recent studies have shown that the correlation between euthyriod population there are levels of thyroid hormone levels and lipids. However, no correlation between the level of thyroid hormone levels and blood free fatty acids, especially in thyroid hormone levels and blood glucose metabolism abnormal state populations of free fatty acids increased the correlation solution little. This study selected the healthy population, impaired glucose tolerance and diabetes, serum lipids, free fatty acids (FFA), thyroid hormone, glycosylated hemoglobin, fasting insulin, insulin resistance index, correlation analysis between FFA and TSH, the correlation between FFA and insulin resistance as well as TSH and bile Sterol correlation. To investigate the correlation between glucose metabolism status and serum free fatty acid and thyroid function. Methods: 75g glucose tolerance test (OGTT) were divided into normal glucose tolerance group (A group), 67 cases of abnormal glucose tolerance in 55 cases (B group), 68 patients with type 2 diabetes patients (C group), impaired fasting blood glucose (IFG) were classified as the diagnostic standard of IGT group.2 meets 1999 WHO on the diagnostic standard of diabetes. Insulin resistance index HOMA-IR= fasting blood glucose (FBG, mmol/L) * fasting insulin levels (FIns, m IU/l /22.5.) application of Elisa kit for detection of free fatty acid; application automatic biochemical detection of blood glucose, serum insulin, blood lipid indexes; thyroid hormone determination of electrochemiluminescence; glycosylated hemoglobin by high-pressure liquid chromatography. Using SPSS18.0 software to analyze the data. Results: the changes in blood of 1 diabetic patients were glycosylated related indicators 绾㈣泲鐧藉湪A缁，

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