甲状腺功能与肥胖及代谢综合征的相关性研究

  本文关键词：甲状腺功能与肥胖及代谢综合征的相关性研究，由笔耕文化传播整理发布。

        研究背景近年来,随着全球经济的快速发展,人们物质生活水平的提高,肥胖的发病率逐年增加,已成为危害人类健康的世界性问题之一。作为一种慢性代谢性疾病,其特点为几种代谢成分异常聚集的病理状态,是一组复杂的代谢紊乱症候群。目前大量的临床研究发现,肥胖与甲状腺功能的变化存在一定关系,甲状腺激素水平的变化可作为体重变化的预测指标,为肥胖的治疗提供新的思路。目的探讨甲状腺功能与肥胖及代谢综合征各组分间的相关性。方法以山东济南重汽集团社区门诊及齐鲁医院查体中心33-71岁自然人群共896例为调查对象,选取BMI≥25.Okg/m2的158例肥胖人群,其中男70例(44.3%),女88例(55.7%)18.5kg/m2≤BIM≤24kg/m2的120例正常人群进入该研究,其中男60例(50.0%),女60例(50.0%),平均年龄53.83±12.77岁。所有调查对象均自愿参加,并签署知情同意书,有经过统一培训合格人员采取统一调查问卷对调查人员进行询问调查,体格检查及实验室检查。采用SPSS13.0软件进行统计分析,计量资料用均数±标准差(x±S)表示,组间比较用t检验,以P<0.05为差异有统计学意义。结果肥胖组、MS组与正常人群组基线值无统计学差异,可比性良好。①单纯肥胖与正常人群比较：与正常人群比较,单纯肥胖者(以BMI计算)收缩压和舒张压均增高,并有统计学差异(P<0.05)；肥胖者血清胰岛素、C-肽和糖化血红蛋白水平均高于正常对照组(分别为p<0.001和p<0.05);肥胖患者甲状腺功能指标中游离甲状腺素(free T4, FT4)和促甲状腺激素(thyroid stimulating hormone, TSH)血清浓度增加,有非常显著性差异(P<0.01)；而游离三碘甲腺原氨酸(freeT3,FT3)水平虽然有下降趋势,但与正常组比较无统计学差异(P>0.05)；肥胖者HDL-C浓度水平显著低于正常人群(P<0.01)；TG无统计学差异(P>0.05)。②符合CDS2004诊断标准MS与正常人群比较：与正常人群相比,MS患者在血压(收缩压和舒张压)、BMI、血清胰岛素、C-肽和糖化血红蛋白水平均显著升高(分别为P<0.01和P<0.001)；而且,血脂水平(HDL-C、TG、CHO)和甲状腺功能三项指标均有统计学差异(P<0.01)。③符合2007《中国成人血脂异常防治指南》诊断标准MS与正常人群比较：与正常人群相比,MS患者在血压(收缩压和舒张压)、BMI、血清胰岛素、C-肽和糖化血红蛋白水平均显著升高(分别为P<0.05,P<0.01和P<0.001)；而血脂水平(HDL-C、TG)和甲状腺功能三项指标均有统计学差异(分别为P<0.05,P<0.01和P<0.001)。④TSH与代谢综合征各组分间的Pearson相关性：在肥胖人群,TSH与收缩压呈正相关(◇p<0.05),与血浆胰岛素水平呈负相关(◆p<0.05)、与C-肽呈负相关(P>0.05)；正常体重人群,TSH与腰臀比、胆固醇呈正相关(’p,’p<0.05),与胰岛素、C-肽呈负相关(P>0.05)。结论无论按照CDS2004标准还是按照2007《中国成人血脂异常防治指南》对MS进行诊断,MS患者与正常人群相比,甲状腺功能三项指标FT3、FT4和TSH均存在显著差异(分别为P<0.05、P<0.01、P<0.001),即使是肥胖或超重患者与正常人群相比,甲状腺功能中的FT4和TSH也存在统计学差异(P<0.01),在MS或肥胖患者FT4和TSH有明显的升高趋势,而FT3有降低趋势,提示甲状腺功能状况可能与MS的发生或发展存在一定的关系,MS患者可能存在甲状腺功能减低或甲状腺激素抵抗现象。

    BackgroundIn the past decades, with the rapid development of economy and the improvement of people’s living standard day by day, a dramatic increased incidence of obesity has been attached overwhelmingly threatening people’s health, which has become a major global health concern. As a chronic metabolic disease, metabolic syndrome is characterized by an aggregation of multiple impaired metabolic components including obesity, hyperinsulinemia, hyperglycemia, hyperlipidemia, hyperuricemia as well as hypertension, which forms an intricate complex of metabolic disorder. Thyroid function, which has been observed to be closely associated with obesity for decades, is now again attracting more attentions of investigators since its intricate mechanisms underlying especially the findings of the novel independent role of thyroid stimulating hormone in adipocytes and obesity associated cardiovasculopathy were further revealed. Alternation in serum thyroid hormones levels especially the thyroid stimulating hormone levels can be referred as a prognostic indicator of metabolic syndrome. And the further study of the exact roles of thyroid hormones in obesity, would undoubtly provide novel insights into the understanding of the pathogenesis as well as the intervention strategies of obesity and its associated metabolic syndrome.ObjectiveTo evaluate the correlativity between serum thyroid hormones levels and the components of metabolic syndrome in euthyroid patients with morbid obesity MethodsIn this randomized, double-blinded study, a subcohort of158people with obesity (BMI≥25. Okg/m2with70male and88female),120people as health controls (18.5kg/m2BIM≤24kg/m2,with60male and60female) were randomly enrolled from a cohort of896people who took part in the routine medical checkup in community clinics of CNHTC JINAN TRUCK CO., LTD and Health examination center of Qilu Hospital of Shandong University. The average age of the participants is64+10years. Before performing the study, we explain the procedure in detail and obtain written informed consent from each participant. A detailed clinical questionnaire was also obtained from each patient including record of history of disease, physical and laboratory examinations by well trained professionals. Statistical procedures were performed with the statistical package PASW13.0. data were represented as Mean+SD (X±S). The Pearson or Spearman correlation test was used for correlation analysis depending on data distribution. Significance is defined as a two tailed P<0.05.ResultsThe demographic baseline parameters has no statistical significant difference among the three groups of participants,①compared with health controls, patients with obesity (defined as BMI≥25.0kg/m2) has significantly elevated systolic blood pressures and diastolic pressures (P<0.05); the levels of serum insulin, C-peptide as well as Hbl Ac are all higher in obese patients than those of health controls (p<0.001and p<0.05respectively). The serum levels of free T4(FT4) and thyroid stimulating hormone (TSH) was increased in euthyroid obese patients and statistically different (P<0.01).However, as for serum levels of free T3(FT3), there is a declining tedency in obseity, but in our present study, the difference is not statistically significa(P>0.05). Serum levels of High-density lipoprotein cholesterol ester (HDL-C) are significantly decreased in obese patients compared with health controls (P<0.01). But the increase in triglycerides are not statistically signifcant in our study (P>0.05).②compared with health people, patients with metabolic syndrome (MS) defined by diagnostic criteria made by Chinese Diabetes Society2004(CDS2004) have significantly elevated levels of blood pressures, body mass index (BMI)(P<0.01), serum insulin (P<0.01), serum C-peptide(P<0.01) and HblAc(P<0.01)。Furthermore, Both the serum lipid (including HDL-C(P<0.01), TG (P<0.01)and total cholesterol(P<0.01)) and the parameters of thyroid function (including TSH, FT4and FT3) reveal significant difference between patients with metabolic syndrome and health people (P<0.01)。③ompared with health people, patients with metabolic syndrome (MS) defined by diagnostic criteria from "Chinese guideline for prevention and treatment of adult dyslipidemia2007", again have significantly elevated levels of blood pressures, body mass index (BMI)(P<0.01), serum insulin (P<0.001), serum C-peptide (P<0.01) and HblAc (P<0.01)。Furthermore, Both the serum lipid (including HDL-C,TG and total cholesterol) and all the three parameters of thyroid function (including TSH (p<0.05), FT4(p<0.01) and FT3(P<0.05)) reveal significant difference between patients with metabolic syndrome and health people (P<0.01) as well。④The correlation study between serum TSH levels and each component of metabolic syndrome reveals significant positive relevance of serum levels of TSH with systolic blood pressures (p<0.05) and significant negative relevance of serum TSH levels with both insulin (p<0.05) and C-peptide (p<0.05) levels in obese patients. In lean health people, the significant positive correlation between serum TSH levels and WHR as well as cholesterol is revealed. Again serum TSH levels are negatively correlated with serum levels of both insulin (p<0.05) and C-peptide (p<0.05)ConclusionIn conclusion, Patients with metabolic syndrome, according to diagnostic criteria formulated by both CDS2004and Chinese guidelines on prevention and treatment of dyslipidemia in adults (2007), has a significant different serum levels of all the three parameters(FT3, FT4, TSH) of thyroid function(with respectively P<0.05、P<0.01、 P<0.001). Significantly elevated serum levels of FT4, together with TSH, was also observed in patients with obesity compared with lean health controls. Taken together, our study implicate that the function status of thyroid hormones may be closely linked to obesity as well as the obesity associated metabolic syndrome. Declined FT3, together with elevated FT4and TSH, may have a role in the pathogenesis of obesity as well as disease progression from obesity into metabolic syndrome.

甲状腺功能与肥胖及代谢综合征的相关性研究

中文摘要6-9ABSTRACT9-12符号说明13-16前言16-18资料与方法18-23结果23-26讨论26-32总结32-34结论34-35附图表35-36参考文献36-43致谢43-44攻读硕士学位期间发表的学术论文目录44-45学位论文评阅及答辩情况表45

  本文关键词：甲状腺功能与肥胖及代谢综合征的相关性研究，，由笔耕文化传播整理发布。