Wang Kun, Yang Yu, Wu Yang, Chen Jie, Zhang Danyu, Mao Xiaodong, Wu Xinping, Long Xianqin, Liu Chao
Departments of Endocrinology (K.W., Y.Y., J.C., D.Z., X.M., C.L.) and Ultrasonography (X.W., X.L.), Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China; and Department of Endocrinology (Y.W.), The First People's Hospital of Changzhou, Third Affiliated Hospital of Suzhou University, Changzhou 213003, China.
J Clin Endocrinol Metab. 2015 Jan;100(1):184-92. doi: 10.1210/jc.2014-2723.
Insulin resistance (IR) is an important factor for the growth and progression of thyroid nodules, which might be associated with the distribution, construction, and density of nodular vascularization.
The objective of the study was to explore the association between IR and the vascularization of thyroid nodules.
A cross-sectional, population-based study was conducted in Nanjing, China, from June to November 2011.
Among 10 050 participants aged 40-79 years, 2886 thyroid nodule cases were detected and 2532 cases met eligibility criteria for enrollment in the study.
Power Doppler was performed to measure the flow patterns, resistive index (RI), and vascular index (VI) of thyroid nodular vascularization. Fasting insulin, fasting glucose, 2-hour oral glucose tolerance test, glycosylated hemoglobin (HbA1c), homeostasis model assessment of IR (HOMA-IR), and body mass index were also tested.
HOMA-IR (R = 0.35, P < .001) and HbA1c (R = 0.19, P < .001) were positively correlated with thyroid nodular flow patterns, and the positive correlations were more significant in participants with large nodules (volume ≥ 0.2 mL). Additionally, in participants with large nodules, HOMA-IR and HbA1c were positively correlated with RI (HOMA-IR: β = .42, SE = .03, R = 0.43, P < .001; HbA1c: β = .22, SE = .04, R = 0.23, P < .001) and VI (HOMA-IR: β = .49, SE = 0.05, R = 0.53, P < .001; HbA1c: β = .34, SE = 0.11, R = 0.37, P < .001).
IR and hyperglycemia were positively correlated with the flow patterns, RI, and VI of thyroid nodules, especially in large nodules. The findings suggest a pivotal role of IR in the distribution, construction, and density of thyroid nodular vascularization, which might contribute to the growth and the progression of thyroid nodules.
胰岛素抵抗（IR）是甲状腺结节生长和进展的重要因素，可能与结节性血管生成的分布、结构和密度有关。
本研究旨在探讨IR与甲状腺结节血管生成之间的关联。
2011年6月至11月在中国南京进行了一项基于人群的横断面研究。
在10050名年龄在40 - 79岁的参与者中，检测出2886例甲状腺结节病例，其中2532例符合纳入本研究的标准。
采用能量多普勒测量甲状腺结节性血管生成的血流模式、阻力指数（RI）和血管指数（VI）。还检测了空腹胰岛素、空腹血糖、口服葡萄糖耐量试验2小时血糖、糖化血红蛋白（HbA1c）、稳态模型评估的IR（HOMA - IR）和体重指数。
HOMA - IR（R = 0.35，P <.001）和HbA1c（R = 0.19，P <.001）与甲状腺结节血流模式呈正相关，且在大结节（体积≥0.2 mL）参与者中这种正相关更显著。此外，在大结节参与者中，HOMA - IR和HbA1c与RI（HOMA - IR：β =.42，SE =.03，R = 0.43，P <.001；HbA1c：β =.22，SE =.04，R = 0.23，P <.001）和VI（HOMA - IR：β =.49，SE = 0.05，R = 0.53，P <.001；HbA1c：β =.34，SE = 0.11，R = 0.37，P <.001）呈正相关。
IR和高血糖与甲状腺结节的血流模式、RI和VI呈正相关，尤其是在大结节中。研究结果表明IR在甲状腺结节性血管生成的分布、结构和密度中起关键作用，这可能有助于甲状腺结节的生长和进展。
