胰岛素抵抗在评估临床及亚临床甲状腺功能减退患者临床结局中的作用。
Effect of insulin resistance in assessing the clinical outcome of clinical and subclinical hypothyroid patients.
作者信息
B Ujwal Upadya, Mn Suma, Km Srinath, Prashant Akila, Doddamani Parveen, Sv Shilpa
机构信息
Assistant Professor, Department of Biochemistry, The Oxford Medical College Hospital and Research Centre , Bangalore, India .
Professor & Head, Department of Biochemistry, JSS Medical College, JSS University , Mysore, India .
出版信息
J Clin Diagn Res. 2015 Feb;9(2):OC01-4. doi: 10.7860/JCDR/2015/9754.5513. Epub 2015 Feb 1.
BACKGROUND
The effect of thyroid status on insulin sensitivity is of great interest but despite various studies there is conflicting data on this subject. Hypothyroidism has been associated with disorders of glucose and insulin metabolism involving defective insulin secretion in response to glucose, hyperinsulinemia, altered peripheral glucose disposal and insulin resistance. Thyroid dysfunction leads to alterations in glucose and lipid metabolism which is an important risk factor for cardiovascular diseases. The dyslipidemia and insulin resistance should be managed aggressively to reduce the impending risk.
OBJECTIVES
The prime objectives of the study were as follows: 1. To compare and correlate insulin resistance levels with T3, T4, and TSH in hypothyroidism patients. 2. To compare and correlate lipid profile with T3, T4, and TSH in hypothyroidism patients with healthy controls.
MATERIALS AND METHODS
Forty hypothyroidism patients and Forty healthy age and sex matched controls in the age group of 18 to 45 years were taken for the study. The venous blood samples collected were used for estimation of thyroid hormones, insulin, glucose and lipid profile.
RESULTS AND DISCUSSION
There is significant increase in insulin, Homa-IR and glucose levels in hypothyroidism cases when compared to controls. Cholesterol, LDL, VLDL and triglycerides were significantly increased, whereas HDL was significantly decreased in hypothyroidism cases when compared with controls. Insulin was moderately correlated with cholesterol but there was no correlation with other lipid profile parameters in hypothyroidism patients. Homa-IR was significantly correlated with TSH in hypothyroidism cases when compared with controls. TSH was significantly correlated with cholesterol and LDL in hypothyroidism cases (both clinical and subclinical) when compared with controls. The present study helps to evaluate changes in insulin resistance and lipid risk factors. These factors should be managed aggressively to reduce the impending risk of cardiovascular diseases.
背景
甲状腺状态对胰岛素敏感性的影响备受关注，但尽管进行了各种研究，关于这一主题的数据仍相互矛盾。甲状腺功能减退与葡萄糖和胰岛素代谢紊乱有关，包括对葡萄糖反应时胰岛素分泌缺陷、高胰岛素血症、外周葡萄糖处置改变和胰岛素抵抗。甲状腺功能障碍会导致葡萄糖和脂质代谢改变，这是心血管疾病的一个重要危险因素。应积极管理血脂异常和胰岛素抵抗以降低潜在风险。
目的
本研究的主要目的如下：1. 比较甲状腺功能减退患者的胰岛素抵抗水平与 T3、T4 和 TSH，并进行相关性分析。2. 将甲状腺功能减退患者的血脂谱与健康对照者的 T3、T4 和 TSH 进行比较并分析相关性。
材料与方法
选取 40 例年龄在 18 至 45 岁之间的甲状腺功能减退患者以及 40 例年龄和性别匹配的健康对照者进行研究。采集的静脉血样本用于检测甲状腺激素、胰岛素、葡萄糖和血脂谱。
结果与讨论
与对照组相比，甲状腺功能减退患者的胰岛素、稳态模型评估胰岛素抵抗（Homa-IR）和血糖水平显著升高。与对照组相比，甲状腺功能减退患者的胆固醇、低密度脂蛋白（LDL）、极低密度脂蛋白（VLDL）和甘油三酯显著升高，而高密度脂蛋白（HDL）显著降低。在甲状腺功能减退患者中，胰岛素与胆固醇呈中度相关，但与其他血脂谱参数无相关性。与对照组相比，甲状腺功能减退患者中 Homa-IR 与促甲状腺激素（TSH）显著相关。与对照组相比，在甲状腺功能减退患者（包括临床和亚临床患者）中，TSH 与胆固醇和 LDL 显著相关。本研究有助于评估胰岛素抵抗和脂质风险因素的变化。应积极管理这些因素以降低心血管疾病的潜在风险。
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