促甲状腺激素对2型糖尿病合并非酒精性脂肪性肝病危险因素的影响

发布时间：2018-06-26 00:35

本文选题：促甲状腺激素 + 糖代谢　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的通过比较2型糖尿病(T2DM)及其合并非酒精性脂肪性肝病(NAFLD)患者甲状腺激素及促甲状腺激素(TSH)水平的变化,分析非酒精性脂肪性肝病危险因素——血糖、血脂、胰岛素敏感性指标变化,探讨TSH水平变化对2型糖尿病合并非酒精性脂肪性肝病危险因素的影响,从而对其发病机制起到一定的作用。方法通过性别、年龄匹配,选择我院2013年10月—2014年2月,5个月间住院T2DM合并NAFLD患者200例,女性105例,男性95例,平均年龄为(50.5±4.7)岁,根据TSH水平,将其分为5.3mIU/LTSH2.5mIU/L组(A组)100位与0.3mIU/LTSH≤2.5mIU/L组(B组)100位,入选标准：①T2DM符合世界卫生组织(WHO)1999年的诊断标准,为糖尿病的症状加任意时间的血浆葡萄糖均大于或等于11.1mmol/L,或者是空腹的血糖(FPG)大于或者等于7.0mmol/L,或者口服葡萄糖耐量试验(OGTT)餐后2小时的血糖(OGTT2hPG)大于或者等于11.1mmol/L,需要在不同时间重复确认,而且空腹指的是隔夜8-12小时内没有任何的热量摄入,任意时间指的是一日内的任何时间,不论上一次进餐的时间以及食物的摄入量；②NAFLD诊断依照腹部的B超,标准参考的是中华医学会2010年的非酒精性脂肪性肝病的诊疗指南,即NAFLD是与胰岛素的抵抗和遗传易感性相关的代谢应激性的肝脏损伤,病理学改变与酒精性的肝病相似,但患者没有过量饮酒和其他明确的肝损害的因素。③所有研究对象甲状腺功能均为正常；剔除标准是：①患者使用了影响甲状腺功能药物的患者；②近3个月内患有急性的疾病,严重的感染,创伤后处于应激状态者；③患有恶性肿瘤的患者;④有严重心、肝、肾脏衰竭和高血压的患者；⑤怀孕或者正在哺乳期的妇女；⑥近期接触了放射线者；⑦患有甲状腺的疾病。下面的各代谢指标：体重指数(BMI)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、载脂蛋白A(Apo-A)、载脂蛋白B(Apo-B)、高密度脂蛋白胆固醇(HDL-C)、空腹的胰岛素(FINS)、空腹的血糖(FBG)及胰岛素抵抗指数(HoMA-IR)、胰岛素敏感指数(ISI)为自变量,以不同TSH水平为应变量作相关分析,观察2DM合并NAFLD患者TSH水平与上述各代谢指标的相关性。所有的正态分布计量资料采用的是均数士标准差(x士s)来表示的,非正态分布的资料经过对数的转换,成为正态分布的资料,正态分布的两组比较采用t检验,P≤0.05为差异有统计学意义；相关的关系分析采用的是多元线性回归分析,P≤0.05为有统计学意义结果 1.两组对甲状腺素水平的影响：两组比较,血清FT3及FT4水平变化,差异有统计学意义(P0.05)。 2.不同TSH水平两组对各代谢指标的作用比较：采用多元线性回归分析,T2DM合并NAFLD患者列入以下指标：TSH(Y)作为应变量、以BMI(X1)、TG(X2)、TC(X3)、LDL-C(X4)、Apo-A(X5)、Apo-B(X6)、HDL-C(X7)、FINS(X8)、FBG(X9)、 HOMA-IR(X10),ISI(X11)为自变量,做相关性分析。结果示：TSH与BMI(X1)、TG(X3)、 LDL-C(X4)、Apo-A(X6)、Apo-B(X7)、FINS(X8)、FBG(X9)、HOMA-IR(X10)呈负相关；与HDL-C(X5),ISI(X11)呈正相关。结论 1.2型糖尿病合并非酒精性脂肪性肝病时,TSH虽在在正常范围内,但较非2型糖尿病合并非酒精性脂肪性肝病时升高。 2.TSH对2型糖尿病合并非酒精性脂肪性肝病产生影响,可以使BMI、TC、TG,LDL-C,Apo-A1,Apo-B,HOMA-IR升高,使HDL-C,ISI降低；TSH通过改变2型糖尿病合并非酒精性脂肪性肝病的危险因素,促进了2型糖尿病合并非酒精性脂肪性肝病的发生及发展。
[Abstract]:Objective to compare the changes in thyroid hormones and thyroid stimulating hormone (TSH) levels in patients with type 2 diabetes (T2DM) and their combination with nonalcoholic fatty liver disease (NAFLD), and to analyze the changes in the risk factors of nonalcoholic fatty liver disease - blood glucose, blood lipid and insulin sensitivity, and to explore the changes of TSH level in the nonalcoholic type of diabetes with type 2 diabetes. The risk factors of fatty liver disease play an important role in the pathogenesis of fatty liver disease.
Methods through sex and age matching, we selected 200 cases of T2DM patients with T2DM in hospital from October 2013 to February 2014, 200 cases of hospitalized patients, 105 women and 95 males, the average age was (50.5 + 4.7) years old. According to the TSH level, they were divided into 5.3mIU/LTSH2.5mIU/L (A group) 100 and 0.3mIU/LTSH < 2.5mIU/L group (B group) 100, the criteria were: 1 T2DM character. The diagnostic standard of the WHO (WHO) 1999 is that the plasma glucose is greater than or equal to or equal to 11.1mmol/L for the symptoms of diabetes at any time, or the fasting blood glucose (FPG) is greater than or equal to 7.0mmol/L, or the oral glucose tolerance test (OGTT) 2 hours after the meal (OGTT2hPG) is greater than or equal to 11.1mmol/L. Repeated confirmation at different times, and the fasting refers to no calorie intake within 8-12 hours of the night, at any time refers to any time within one day, no matter the time of the last meal and the intake of food. (2) the NAFLD diagnosis is based on the B-ultrasound of the abdomen. The standard reference is the non-alcoholic fatty liver of the Chinese Medical Association in 2010. A guide to diagnosis and treatment of the disease, that is, NAFLD is a metabolic stress liver injury associated with insulin resistance and genetic susceptibility. Pathological changes are similar to alcoholic liver diseases, but the patients have no excessive drinking and other definite liver damage. 3. All the subjects of the study are normal; the elimination standard is: 1 patients make Patients with thyroid function drugs were used; (2) patients with acute disease, severe infection and stress in the last 3 months; (3) patients with malignant tumors; (4) patients with serious heart, liver, kidney failure and hypertension; (5) pregnant or breast feeding women; 6. The following metabolic markers: body mass index (BMI), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), apolipoprotein A (Apo-A), apolipoprotein B (Apo-B), high density lipoprotein cholesterol (HDL-C), fasting insulin (FINS), fasting blood glucose (FBG) and insulin resistance index (HoMA-IR), pancreas The island element sensitivity index (ISI) is the independent variable, and the correlation analysis is made with the different TSH level as the corresponding variable. The correlation between the TSH level of the 2DM combined with NAFLD and the above metabolic indexes is observed. All the normal distribution data are expressed by the standard deviation (x s), and the data of the non normal distribution become normal points through the logarithmic transformation. The data of cloth and two groups of normal distribution were compared by t test, and the difference was statistically significant in P < 0.05. The correlation analysis adopted multivariate linear regression analysis, and P < 0.05 was statistically significant.
Result
1. the influence of the two groups on thyroxine level: there was a significant difference in serum FT3 and FT4 levels between the two groups (P0.05).
2. the effect of different TSH level two groups on each metabolic index: using multiple linear regression analysis, T2DM combined with NAFLD patients included the following indexes: TSH (Y) as a variable, BMI (X1), TG (X2), TC (X3), pluralistic. TSH is negatively correlated with BMI (X1), TG (X3), LDL-C (X4), Apo-A (X6), Apo-B (X7), Apo-B (E), (()) and (()), and is positively correlated with (()) and (()).
conclusion
When type 1.2 diabetes is associated with nonalcoholic fatty liver disease, although TSH is in normal range, it is higher than non type 2 diabetes complicated with nonalcoholic fatty liver disease.
2.TSH has an effect on type 2 diabetes with non-alcoholic fatty liver disease, which can make BMI, TC, TG, LDL-C, Apo-A1, Apo-B, HOMA-IR increase and reduce HDL-C and ISI; TSH by changing the risk factors of type 2 diabetes with non-alcoholic fatty liver disease promotes the occurrence and development of type 2 glycan disease combined with nonalcoholic fatty liver disease.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.1;R575.5

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