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甲状腺功能障碍治疗前后血清脂联素水平及糖代谢变化

Serum Adiponectin Levels and Changes in Glucose Metabolism before and after Treatment for Thyroid Dysfunction.

作者信息

Ozdemir Didem, Dagdelen Selcuk, Usman Aydan

机构信息

Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Turkey.

出版信息

Intern Med. 2015;54(15):1849-57. doi: 10.2169/internalmedicine.54.0668. Epub 2015 Aug 1.

Abstract

OBJECTIVE

Adiponectin is an adipokine which is known to decrease in individuals associated with obesity and insulin resistance. In this study, we aimed to investigate the serum adiponectin levels and glucose metabolism in patients with thyroid dysfunction before and after treatment.

METHODS

Newly diagnosed overt hypothyroid (n=20) and thyrotoxic (n=23) patients and healthy controls (n=20) with a body mass index of <30 kg/m(2) were evaluated prospectively. Patients with a known state of insulin resistance, including prediabetes and overt diabetes, and individuals with chronic diseases were excluded. Thyroid function and fasting plasma glucose (FPG), insulin, homeostatic model assessment (HOMA) insulin resistance (HOMA-IR) and HOMA-beta cell function (HOMA-beta), lipid and adiponectin levels were investigated in the basal state and after the restoration of euthyroidism.

RESULTS

The basal fasting FPG levels were lower in the hypothyroid patients than the control subjects (p=0.02) and similar between the thyrotoxic patients and control subjects (p=0.127). The basal HOMA-beta levels were higher in the patients with hypothyroidism than in those with thyrotoxicosis (p=0.015). Following the restoration of euthyroidism, the FPG levels significantly increased in the hypothyroid patients (p=0.002) and decreased in the thyrotoxic (p=0.001) patients. The basal plasma adiponectin levels were 14.55±8.4 mcg/mL, 13.79±9.13 mcg/mL and 11.68±6.0 mcg/mL in the hypothyroid and thyrotoxic patients and healthy controls, respectively (p=0.503). The adiponectin levels decreased significantly in the patients with hypothyroidism (p=0.047), whereas they did not change in the patients with thyrotoxicosis (p=0.770) after achieving euthyroidism.

CONCLUSION

In this study, following the restoration of euthyroidism, the FPG levels increased in the hypothyroidism patients and decreased in the thyrotoxicosis patients, despite the lack of changes in the HOMA-IR and HOMA-beta levels. Meanwhile, the hypothyroid, thyrotoxic and euthyroid subjects had similar basal adiponectin levels, and a significant decrease in the adiponectin levels was observed after treatment for hypothyroidism, despite the absence of changes after treatment for thyrotoxicosis, indicating the need for further studies with a larger sample size.

摘要

目的

脂联素是一种脂肪因子,已知在肥胖和胰岛素抵抗个体中水平会降低。在本研究中,我们旨在调查甲状腺功能障碍患者治疗前后的血清脂联素水平和糖代谢情况。

方法

对新诊断的显性甲状腺功能减退患者(n = 20)、甲状腺毒症患者(n = 23)以及体重指数<30 kg/m²的健康对照者(n = 20)进行前瞻性评估。排除已知存在胰岛素抵抗状态的患者,包括糖尿病前期和显性糖尿病患者,以及患有慢性疾病的个体。在基础状态和甲状腺功能恢复正常后,对甲状腺功能、空腹血糖(FPG)、胰岛素、稳态模型评估(HOMA)胰岛素抵抗(HOMA-IR)和HOMA-β细胞功能(HOMA-β)、血脂及脂联素水平进行研究。

结果

甲状腺功能减退患者的基础空腹FPG水平低于对照组(p = 0.02),甲状腺毒症患者与对照组相似(p = 0.127)。甲状腺功能减退患者的基础HOMA-β水平高于甲状腺毒症患者(p = 0.015)。甲状腺功能恢复正常后,甲状腺功能减退患者的FPG水平显著升高(p = 0.002),甲状腺毒症患者的FPG水平降低(p = 0.001)。甲状腺功能减退患者、甲状腺毒症患者和健康对照者的基础血浆脂联素水平分别为14.55±8.4 mcg/mL、13.79±9.13 mcg/mL和11.68±6.0 mcg/mL(p = 0.503)。甲状腺功能恢复正常后,甲状腺功能减退患者的脂联素水平显著降低(p = 0.047),而甲状腺毒症患者的脂联素水平无变化(p = 0.770)。

结论

在本研究中,甲状腺功能恢复正常后,尽管HOMA-IR和HOMA-β水平无变化,但甲状腺功能减退患者的FPG水平升高,甲状腺毒症患者的FPG水平降低。同时,甲状腺功能减退、甲状腺毒症和甲状腺功能正常的受试者基础脂联素水平相似,甲状腺功能减退治疗后脂联素水平显著降低,而甲状腺毒症治疗后无变化,表明需要进行更大样本量的进一步研究。

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