Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Jinan, China.
Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Front Endocrinol (Lausanne). 2022 Mar 1;13:806349. doi: 10.3389/fendo.2022.806349. eCollection 2022.
The correlation of abnormal glucose metabolism and thyroid carcinoma, especially the aggressiveness of thyroid cancer, still remains controversial. We conducted this study to investigate the relationship between abnormal glucose metabolism parameters and differentiated thyroid carcinoma (DTC) in the Chinese population.
The study was designed as a hospital-based case-control study and was approved by the Ethics Committee of our hospital and registered in the Clinical Trial Protocol Registration and Results System (Registration code: NCT03006289). From January 1, 2018 to June 30, 2021, a total of 377 DTC patients were enrolled in the study. Demographic and general characteristics, details of thyroid surgery and histopathological results, hematological test indicators were collected. Glucose metabolism parameters were calculated. Variables were analyzed by t-test, ANOVA, chi-squared analysis and Fisher's exact test. Pearson bi-variate correlation and Spearman's correlation analysis were used for bi-variate analysis.
More than 40% of patients with DTC were multifocality, more than half were extra-glandular invasion, and nearly 85% complied by lymph node metastasis. The prevalence of diabetes mellitus (DM) was about 10.08% in DTC patients. It was found that the proportion of postprandial 2 h blood glucose ≥11.1mmol/L and HbA1c ≥6.5% was significantly higher than the known proportion of DM (17.8%, 16.7% vs. 10.08%). Additionally, 87.3% of the DTC patients in this study had varying degrees of insulin resistance. Further analysis found that higher T staging was associated with higher levels of area under curve of C-peptide ( = 0.029), insulin sensitivity index ( = 0.012) and C-peptide sensitivity index ( = 0.016). A delayed peak of insulin secretion was found to be positive related with capsule invasion (r = 0.206, = 0.004). In patients without a DM history, homeostasis model assessment of insulin resistance ( = 0.017), insulin sensitivity index ( = 0.019) and C-peptide sensitivity index ( = 0.020) were statistic associated with T staging. Also, the glucose metabolism parameter at 3-hour after a meal was related to a larger number of metastatic lymph nodes.
Abnormal glucose metabolism, namely, DM, hyperinsulinemia and insulin resistance, were significantly associated with the carcinogensis and aggressiveness of DTC.
异常葡萄糖代谢与甲状腺癌的相关性，尤其是甲状腺癌的侵袭性，仍存在争议。我们进行这项研究旨在探讨异常葡萄糖代谢参数与中国人群分化型甲状腺癌（DTC）之间的关系。
本研究为医院为基础的病例对照研究，得到了我院伦理委员会的批准，并在临床试验方案注册和结果系统（注册号：NCT03006289）中注册。自 2018 年 1 月 1 日至 2021 年 6 月 30 日，共纳入 377 例 DTC 患者。收集人口统计学和一般特征、甲状腺手术和组织病理学结果详细信息、血液学检查指标。计算葡萄糖代谢参数。采用 t 检验、方差分析、卡方检验和 Fisher 确切检验对变量进行分析。采用 Pearson 双变量相关和 Spearman 相关分析进行双变量分析。
超过 40%的 DTC 患者为多发病灶，超过一半为腺体外侵犯，近 85%有淋巴结转移。DTC 患者中糖尿病（DM）的患病率约为 10.08%。结果发现，餐后 2 小时血糖≥11.1mmol/L 和 HbA1c≥6.5%的比例明显高于已知 DM 比例（17.8%、16.7%比 10.08%）。此外，该研究中 87.3%的 DTC 患者存在不同程度的胰岛素抵抗。进一步分析发现，较高的 T 分期与曲线下面积的 C 肽（ = 0.029）、胰岛素敏感性指数（ = 0.012）和 C 肽敏感性指数（ = 0.016）升高相关。胰岛素分泌峰值延迟与囊外侵犯呈正相关（r = 0.206， = 0.004）。在无 DM 病史的患者中，稳态模型评估的胰岛素抵抗（ = 0.017）、胰岛素敏感性指数（ = 0.019）和 C 肽敏感性指数（ = 0.020）与 T 分期有统计学关联。此外，餐后 3 小时的葡萄糖代谢参数与更多的转移性淋巴结相关。
异常葡萄糖代谢，即糖尿病、高胰岛素血症和胰岛素抵抗，与 DTC 的发生和侵袭性显著相关。
