Jayanthi Rajendran, Srinivasan Abu Raghavan, Hanifah Mohammed, Maran Anandraj Lokesh
Department of Biochemistry, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth, Pondicherry 607403, India.
Department of Biochemistry, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth, Pondicherry 607403, India.
Diabetes Metab Syndr. 2017 Nov;11 Suppl 1:S121-S126. doi: 10.1016/j.dsx.2016.12.020. Epub 2016 Dec 23.
Triacylglycerol/High density lipoprotein (TAG/HDL) ratio, a surrogate marker of LDL particle size (small dense) was included in our study to observe the link with insulin resistance and thyroid co-morbidity.
Ninety three patients with T2DM of both genders were enrolled from a tertiary health care unit in Puducherry, during the latter half of 2015. The cardio-metabolic risk factors were assessed through body mass index (BMI), blood pressure, fasting blood glucose and lipid profile, glycated haemoglobin and homeostasis model assessment of insulin resistance (HOMA-IR). Serum free T4, T3 and TSH were also measured to evaluate the thyroid co-morbidity as a function of insulin resistance.
In addition to insulin resistance, results of our study were focussed on thyroid comorbidity. In overweight diabetic patients, the ROC curve analyses demonstrated that the best marker for insulin resistance was Triacylglycerol/High density lipoprotein (TAG/HDL), with the area under the ROC curve being 0.902. Thyroxine (T4) was less significant when compared to TAG/HDL with area under the ROC curve of 0.583. Triiodothyronine (T3) and T4 were more significant in obese group with areas under the curve being 0.842 and 0.816 respectively when compared against insulin resistance (cut-off value for HOMA-IR 2.69). The optimal cut-off points for overweight were: TAG≥101mg/dl; T4≥1.16ng/dl; TAG/HDL≥2.26 whereas for obese: TC≥163.5mg/dl; TAG≥141.5mg/dl; T3≥2.42pg/ml; T4≥0.96ng/ml.
In overweight type 2 diabetics, TAG/HDL ratio could be used as a reliable marker for insulin resistance with thyroid co-morbidity and T3, T4 were better objective markers in obese type 2 diabetics.
本研究纳入甘油三酯/高密度脂蛋白（TAG/HDL）比值，作为低密度脂蛋白颗粒大小（小而密）的替代标志物，以观察其与胰岛素抵抗及甲状腺共病的关联。
2015年下半年，从本地治里的一家三级医疗保健机构招募了93例2型糖尿病患者，男女不限。通过体重指数（BMI）、血压、空腹血糖和血脂谱、糖化血红蛋白以及胰岛素抵抗的稳态模型评估（HOMA-IR）来评估心血管代谢危险因素。还测量血清游离T4、T3和促甲状腺激素（TSH），以评估作为胰岛素抵抗函数的甲状腺共病情况。
除胰岛素抵抗外，我们的研究结果还聚焦于甲状腺共病。在超重糖尿病患者中，ROC曲线分析表明，胰岛素抵抗的最佳标志物是甘油三酯/高密度脂蛋白（TAG/HDL），ROC曲线下面积为0.902。与TAG/HDL相比，甲状腺素（T4）的意义较小，ROC曲线下面积为0.583。与胰岛素抵抗（HOMA-IR的截断值为2.69）相比，三碘甲状腺原氨酸（T3）和T4在肥胖组中更具意义，曲线下面积分别为0.842和0.816。超重患者的最佳截断点为：TAG≥101mg/dl；T4≥1.16ng/dl；TAG/HDL≥2.26，而肥胖患者为：总胆固醇（TC）≥163.5mg/dl；TAG≥141.5mg/dl；T3≥2.42pg/ml；T4≥0.96ng/ml。
在超重的2型糖尿病患者中，TAG/HDL比值可作为胰岛素抵抗合并甲状腺共病的可靠标志物，而T3、T4在肥胖的2型糖尿病患者中是更好的客观标志物。
