Rogowicz-Frontczak Anita, Pilacinski Stanislaw, Chwialkowska Anna Teresa, Naskret Dariusz, Zozulinska-Ziolkiewicz Dorota
a Department of Internal Medicine and Diabetology , Poznan University of Medical Sciences , Poznan , Poland.
Scand J Clin Lab Invest. 2018 Jul;78(4):287-292. doi: 10.1080/00365513.2018.1455221. Epub 2018 Apr 19.
To investigate the effect of insulin resistance (IR) on thyroid function, thyroid autoimmunity (AIT) and thyroid volume in type 1 diabetes (T1DM). 100 consecutive patients with T1DM aged 29 (±6) years with diabetes duration 13 (±6) years were included. Exclusion criteria were: history of thyroid disease, current treatment with L-thyroxin or anti-thyroid drugs. Evaluation of thyroid stimulating hormone (TSH), free thyroid hormones and anti-thyroid antibodies was performed. Thyroid volume was measured by ultrasonography. IR was assessed using the estimated glucose disposal rate (eGDR) formula. In the study group 22% of subjects had insulin resistance defined as eGDR lower or equal to 7.5 mg/kg/min. The prevalence of thyroid autoimmunity (positivity for ATPO or ATg or TRAb) in the study group was 37%. There were no significant differences in the concentration of TSH, FT3, FT4, the prevalence of AIT and hypothyroidism between IR and insulin sensitive (IS) group. Mean (±SD) thyroid volume was 15.6 (±6.2) mL in patients with IR and 11.7 (±4.7) mL in IS subjects (p = .002). Thyroid volume correlated inversely with eGDR (r = -0.35, p < .001). In a multivariate linear regression model the association between thyroid volume and eGDR was independent of sex, age, duration of diabetes, daily insulin dose, BMI, cigarette smoking, TSH value and presence of thyroid autoimmunity (beta: -0.29, p = .012). Insulin resisance is associated with larger thyroid volume in patients with type 1 diabetes independently of sex, body mass index, TSH value and presence of autoimmune thyroid disease.
为研究胰岛素抵抗(IR)对1型糖尿病(T1DM)患者甲状腺功能、甲状腺自身免疫(AIT)及甲状腺体积的影响。纳入100例连续的T1DM患者,年龄29(±6)岁,糖尿病病程13(±6)年。排除标准为:有甲状腺疾病史、目前正在接受左甲状腺素或抗甲状腺药物治疗。对促甲状腺激素(TSH)、游离甲状腺激素及抗甲状腺抗体进行评估。通过超声测量甲状腺体积。使用估计的葡萄糖处置率(eGDR)公式评估IR。在研究组中,22%的受试者存在胰岛素抵抗,定义为eGDR低于或等于7.5mg/kg/min。研究组中甲状腺自身免疫(ATPO或ATg或TRAb阳性)的患病率为37%。IR组和胰岛素敏感(IS)组在TSH、FT3、FT4浓度、AIT患病率及甲状腺功能减退方面无显著差异。IR患者的平均(±标准差)甲状腺体积为15.6(±6.2)mL,IS受试者为11.7(±4.7)mL(p = 0.002)。甲状腺体积与eGDR呈负相关(r = -0.35,p < 0.001)。在多变量线性回归模型中,甲状腺体积与eGDR之间的关联独立于性别、年龄、糖尿病病程、每日胰岛素剂量、BMI、吸烟、TSH值及甲状腺自身免疫的存在(β:-0.29,p = 0.012)。1型糖尿病患者的胰岛素抵抗与更大的甲状腺体积相关,且独立于性别、体重指数、TSH值及自身免疫性甲状腺疾病的存在。
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