2型糖尿病患者糖化血红蛋白与甲状腺激素水平的相关性研究

发布时间：2018-12-06 16:07

【摘要】：目的:探讨2型糖尿病患者糖化血红蛋白(HbA1c)与血清甲状腺激素水平的相关性。方法:收集了2016年1月-12月在我院内分泌科住院的2型糖尿病患者,严格按照纳入排除标准后,共纳入2型糖尿病患者648例进行分析。记录患者的性别、年龄、身高、体重、肝肾功能、血糖血脂、糖化血红蛋白(Hb A1c)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH),既往史包括严重的心肝肾疾病、甲状腺疾病及手术、药物治疗史等。统计学方法主要有独立样本t检验、单因素方差分析或非参数秩和检验进行各个组间甲状腺激素水平的比较,单因素相关性分析(Pearson或Spearman)分析糖化血红蛋白及其他代谢指标与甲状腺激素水平的关系,在校正了混杂因素后运用逐步多重线性回归,探讨糖化血红蛋白与甲状腺激素水平的相关性。结果:1、通过对收集的648例2型糖尿病患者根据2007年《中国2型糖尿病防治指南》血糖控制状态分为HbA1c6.5%为控制良好,HbA1c6.5-7.5%为控制一般,HbA1c7.5%为控制较差,根据血糖控制情况,在所收集的病例中,仅有9.0%的患者血糖控制良好,有20.0%的患者血糖控制一般,而大部分糖尿病患者血糖控制较差,占71.0%。2、在糖尿病病程、TC、TG、LDL-C水平在三组间存在差异(P0.05),且随着糖化血红蛋白水平的增高,糖尿病病程、TC、TG、LDL-C水平也在增大。在性别、年龄、收缩压、舒张压、BMI、HDL-C水平之间三组未见明显的统计学意义(P0.05)。在三组不同血糖控制组中,发现三组之间的甲状腺抗体阳性率及糖尿病并发症未见有差别(P0.05)。3、FT3水平随着糖尿病病程、年龄、血糖控制较差而降低(P0.01),且女性FT3水平明显低于男性;FT4水平随着年龄的增大而降低(P0.05),但在血糖控制较差组中明显的高于血糖控制良好组;TSH水平在不同组中有下降趋势,但在各组中没有统计学意义(P0.05)。4、HbA1c与甲状腺激素水平的单因素性相关性分析中发现,糖化血红蛋白与FT3、LogTSH水平均呈负相关(r=-0.276,P0.01;r=-0.099,P0.05),而与FT4水平呈正相关(r=0.105,P0.01);多重线性回归中,以甲状腺激素FT3、FT4、LogTSH分别作为因变量,在校正了性别、年龄、糖尿病病程、收缩压、舒张压、BMI、TG、HDL、肌酐、尿酸混杂因素后,HbA1c仍与FT3水平呈负相关(t=-6.992,P=0.000);HbA1C仍与LogTSH水平呈负相关(t=-2.231,P=0.026),HbA1c仍与FT4水平呈正相关(t=2.546,P=0.011)。结论:住院2型糖尿病患者的血糖控制较差。在甲状腺功能正常的2型糖尿病患者中,HbA1c与FT3、TSH水平呈负相关,与FT4水平呈正相关。
[Abstract]:Objective: to investigate the correlation between serum thyroid hormone and glycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus. Methods: a total of 648 patients with type 2 diabetes mellitus were collected from January to December 2016, who were admitted to the Department of Endocrinology in our hospital. Gender, age, height, weight, liver and kidney function, blood glucose, blood lipid, glycosylated hemoglobin (Hb A1c), free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), were recorded. Past history includes severe heart, liver and kidney disease, thyroid disease and surgery, history of drug therapy, etc. Statistical methods included independent sample t-test, univariate ANOVA or non-parametric rank sum test to compare thyroid hormone levels among groups. Univariate correlation analysis (Pearson or Spearman) was used to analyze the relationship between glycosylated hemoglobin and other metabolic indexes and thyroid hormone levels. After adjusting for confounding factors, stepwise multiple linear regression was used. To investigate the correlation between glycosylated hemoglobin and thyroid hormone level. Results: 1. According to the status of blood glucose control of 648 patients with type 2 diabetes mellitus in China in 2007, HbA1c6.5% was classified as good control and HbA1c6.5-7.5% as general control. According to the blood sugar control condition, only 9.0% of the patients had good blood glucose control, 20.0% of the patients had moderate control of blood sugar, and most of the patients with diabetes had poor control of blood sugar. In the course of diabetes, the level of TC,TG,LDL-C was different among the three groups (P0.05), and with the increase of glycosylated hemoglobin, the level of TC,TG,LDL-C also increased in the course of diabetes. Gender, age, systolic blood pressure, diastolic blood pressure, BMI,HDL-C levels were not statistically significant (P0.05). There was no difference in positive rate of thyroid antibody and diabetic complications among the three groups (P0.05). The level of FT3 decreased with the course of diabetes, age and poor blood glucose control (P0.01). The level of FT3 in females was significantly lower than that in males. The level of FT4 decreased with the increase of age (P0.05), but it was significantly higher in the group with poor blood glucose control than that in the group with good blood glucose control. The level of TSH decreased in different groups, but there was no statistical significance in each group (P0.05). 4 the univariate correlation analysis of HbA1c and thyroid hormone levels showed that glycosylated hemoglobin (HbA1c) was associated with FT3,. The level of LogTSH was negatively correlated (r = -0.276, P 0.01). There was a positive correlation between the level of FT4 and the level of FT4 (P < 0.05), but there was a positive correlation with the level of FT4 (r = 0.105, P 0.01). In multiple linear regression, thyroid hormone FT3,FT4,LogTSH was used as dependent variable, after adjusting for sex, age, course of diabetes, systolic blood pressure, diastolic blood pressure, BMI,TG,HDL, creatinine, uric acid mixed factors. There was still a negative correlation between HbA1c and FT3 (t = -6.992, P < 0. 000). There was still a negative correlation between HbA1C and LogTSH (t = 2.231) and a positive correlation between HbA1c and FT4 (t = 2.546). Conclusion: the blood glucose control of type 2 diabetes patients in hospital is poor. In type 2 diabetes patients with normal thyroid function, HbA1c was negatively correlated with FT3,TSH and positively correlated with FT4.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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