糖尿病甲状腺功能正常患者的甲状腺激素变化
Thyroid Hormone Changes in Euthyroid Patients with Diabetes.
作者信息
Qin Ken, Zhang Fan, Wu Qinqin, Liu Zhenrong, Huang Yan, Tan Jing, Zhou Yiling, An Zhenmei, Li Shuangqing, Li Sheyu
机构信息
Physical Examination Center, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.
Chinese Evidence-Based Medicine Center CREAT Group, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.
出版信息
Diabetes Metab Syndr Obes. 2020 Jul 16;13:2533-2540. doi: 10.2147/DMSO.S260039. eCollection 2020.
BACKGROUND
Thyroid dysfunction is associated with diabetes, but it is unclear if the thyroid hormone levels change in euthyroid adults with diabetes.
OBJECTIVE
To investigate the association between thyroid hormone levels and diabetes in euthyroid adults.
METHODS
Among the euthyroid adults who underwent health examination in West China Hospital of Sichuan University in 2016, patients with diabetes were identified according to the medical history, fasting blood glucose and HbA1c. Age and sex matched controls were identified from the population. The patients with diabetes group was further divided into two subgroups: patients with newly diagnosed diabetes (NDD) and with previously diagnosed diabetes (PDD). Independent -test and multivariate logistic regression models were used to investigate the difference in the levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3) and the ratio of FT4/FT3 between groups.
RESULTS
We included 32,557 participants, 2,271 with diabetes. Compared to the adults without diabetes, the odds ratios (ORs) per one unit elevation of TSH, FT4, FT4/FT3 ratio and FT3 in patients with diabetes were 0.88 [95% confidence interval (CI): 0.82-0.95], 1.11 (95% CI: 1.08-1.14), 2.05 (95% CI: 1.81-2.32) and 0.85 (95% CI: 0.78-0.93), respectively. Compared to the NDD group, the ORs per one unit elevation of TSH, FT4, FT4/FT3 ratio and FT3 of the PDD group were 0.81 (95% CI: 0.71-0.92), 1.08 (95% CI: 1.04-1.12), 1.76 (95% CI: 1.49-2.08) and 1.01 (95% CI: 0.92-1.12), respectively.
CONCLUSION
In euthyroid adults, diabetes was associated with increased FT4/FT3 ratio, which is linked to the peripheral turnover of the thyroid hormones.
背景
甲状腺功能障碍与糖尿病相关，但甲状腺激素水平在甲状腺功能正常的糖尿病成年患者中是否发生变化尚不清楚。
目的
研究甲状腺功能正常的成年患者甲状腺激素水平与糖尿病之间的关联。
方法
在2016年于四川大学华西医院进行健康体检的甲状腺功能正常的成年患者中，根据病史、空腹血糖和糖化血红蛋白确定糖尿病患者。从人群中确定年龄和性别匹配的对照组。糖尿病患者组进一步分为两个亚组：新诊断糖尿病患者（NDD）和既往诊断糖尿病患者（PDD）。采用独立样本t检验和多因素logistic回归模型研究促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）水平及FT4/FT3比值在各组间的差异。
结果
我们纳入了32557名参与者，其中2271名患有糖尿病。与无糖尿病的成年人相比，糖尿病患者TSH、FT4、FT4/FT3比值和FT3每升高一个单位的比值比（OR）分别为0.88 [95%置信区间（CI）：0.82 - 0.95]、1.11（95%CI：1.08 - 1.14）、2.05（95%CI：1.81 - 2.32）和0.85（95%CI：0.78 - 0.93）。与NDD组相比，PDD组TSH、FT4、FT4/FT3比值和FT3每升高一个单位的OR分别为0.81（95%CI：0.71 - 0.92）、1.08（95%CI：1.04 - 1.12）、1.76（95%CI：1.49 - 2.08）和1.01（95%CI：0.92 - 1.12）。
结论
在甲状腺功能正常的成年人中，糖尿病与FT4/FT3比值升高有关，这与甲状腺激素的外周代谢有关。
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