本文選題：促甲狀腺激素(TSH)　切入點(diǎn)：游離脂肪酸(FFA)　出處：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:隨著我國經(jīng)濟(jì)的快速發(fā)展,居民的膳食結(jié)構(gòu)發(fā)生了很大的改變,脂肪類食物的攝入超標(biāo),糖脂代謝異常成為普遍現(xiàn)象。我們前期的研究發(fā)現(xiàn)在糖代謝異常的患者血中游離脂肪酸升高,特別是飽和脂肪酸的增多更加明顯。游離脂肪酸的增多對促進(jìn)胰島素抵抗的形成起到了重要作用,深入研究游離脂肪酸增加的因素,對改善糖代謝異常和胰島素抵抗有重要意義。近年來對甲狀腺功能的研究顯示,甲狀腺激素的水平可以影響脂代謝的調(diào)節(jié)。甲狀腺功能減退(甲減)患者出現(xiàn)血膽固醇水平的升高等血脂異常已被大家所認(rèn)識,單純亞臨床甲減對血脂影響的研究也已經(jīng)表明,常伴有總膽固醇(total cholesterol,TC)、低密度脂蛋白膽固醇(low-density lipoprotein cholesterol,LDL-C)增高及高密度脂蛋白膽固醇(high-densitylipoprotein cholesterol,HDL-C)降低。近年的研究表明,在甲狀腺功能正常的人群中也存在甲狀腺激素水平與血脂水平的相關(guān)性。但是,甲狀腺激素水平與血游離脂肪酸的水平的相關(guān)性研究不多,特別是在糖代謝異常狀態(tài)人群甲狀腺激素水平與血游離脂肪酸的增多的相關(guān)性了解甚少。本研究選取健康人群、糖耐量減低人群和糖尿病人群,測定血脂、游離脂肪酸(FFA)、甲狀腺激素、糖化血紅蛋白、空腹胰島素、胰島素抵抗指數(shù)、分析FFA與TSH之間的相關(guān)性、FFA與胰島素抵抗的相關(guān)性以及TSH與膽固醇的相關(guān)性。探討不同糖代謝狀態(tài)人群血清游離脂肪酸與甲狀腺功能狀態(tài)的相關(guān)性。方法:采用75g葡萄糖耐量實(shí)驗(yàn)(OGTT)分為糖耐量正常者67例(A組)、糖耐量異常者55例(B組)、2型糖尿病患者68例(C組),空腹的血糖受損(IFG)者歸為IGT組。2型糖尿病診斷標(biāo)準(zhǔn)符合1999年WHO關(guān)于糖尿病診斷標(biāo)準(zhǔn)。胰島素抵抗指數(shù)HOMA-IR=空腹血糖(FBG,mmol/L)×空腹胰島素水平(FIns,m IU/l)/22.5。應(yīng)用Elisa試劑盒檢測游離脂肪酸;應(yīng)用全自動生化儀檢測血糖、血脂等指標(biāo);血清胰島素、甲狀腺激素測定應(yīng)用電化學(xué)發(fā)光法;糖化血紅蛋白應(yīng)用高壓液相色譜法。用SPSS18.0軟件分析數(shù)據(jù)。結(jié)果:1各組患者糖尿病相關(guān)指標(biāo)的變化糖化血紅蛋白在A組、B組、C組之間存在差異,A組與C組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。FINS:A組8.39±6.43μU/ml、B組11.87±5.96μU/ml、C組11.93±12.67μU/ml。各組空腹胰島素逐漸增加,A組與B組、C組比較均有統(tǒng)計(jì)學(xué)差異(P0.05),但B組與C組無統(tǒng)計(jì)學(xué)差異。HOMA-IR:A組2.00±1.84、B組2.99±1.55、C組4.45±5.05,A組與B組之間及A組與C組之間均有明顯差異。HOMA-β:A組96.21±53.60、B組126.60±111.62、C組66.92±82.42,A組與B組之間差異明顯(P0.05),C組數(shù)值明顯降低,與A組、B組之間明顯差異(P0.05)。2各組患者血脂相關(guān)指標(biāo)的變化FFA:A組54.21±19.18 pg/ml、B組71.28±42.55 pg/ml、C組71.39±26.82 pg/ml,A組與B組、C組出現(xiàn)明顯差異(P0.05),但糖尿病組與糖耐量減低組之間無明顯差異(P0.05)�？偰懝檀�:A組4.68±0.79mmol/l、B組5.05±0.89 mmol/l、C組4.81±1.07 mmol/l.A組與B組差異有統(tǒng)計(jì)學(xué)意義,但B組與C組之間差異無統(tǒng)計(jì)學(xué)意義。高密度脂蛋白膽固醇:A組1.52±0.39 mmol/l、B組1.30±0.30 mmol/l、C組1.02±0.26mmol/l。低密度脂蛋白膽固醇:A組2.53±0.74 mmol/l、B組3.61±0.82mmol/l、C組3.16±1.01 mmol/l,A組與B組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3各組甲狀腺功能相關(guān)激素的變化TSH:A組2.05±0.88μIU/ml、B組2.48±1.54μIU/ml、C組1.76±0.85μIU/ml,A組與B組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。TT3:A組1.80±0.36 nmol/l、B組1.95±0.89 nmol/l、C組1.67±0.30 nmol/l,A組與B組差異無統(tǒng)計(jì)學(xué)意義(P0.05),C組與B組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。TT4:A組104.47±23.92 nmol/l、B組109.21±24.20 nmol/l、C組92.85±31.62nmol/l,A組與B組差異無統(tǒng)計(jì)學(xué)意義(P0.05),C組與A、B組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4游離脂肪酸與促甲狀腺激素相關(guān)性不同糖耐量狀態(tài)下,血清游離脂肪酸與促甲狀腺激素呈正相關(guān),r=0.671,P0.05。同時(shí),游離脂肪酸與高密度脂蛋白負(fù)相關(guān),r=-0.141,P0.05;游離脂肪酸與低密度脂蛋白正相關(guān),r=0.157,P0.05。血促甲狀腺激素與糖化血紅蛋白負(fù)相關(guān),r=-0.181,P0.05。促甲狀腺激素與總膽固醇正相關(guān),r=0.172,P0.05。結(jié)論:1糖耐量減低人群存在游離脂肪酸的升高。2糖耐量減低人群血清游離脂肪酸的升高與促甲狀腺激素的水平有關(guān)。
[Abstract]:Objective: with the rapid development of China's economy, great changes of dietary structure of residents, fat food intake exceed the standard, abnormal Glucolipids metabolism has become a common phenomenon. Our previous study found that free fatty acids in patients with abnormal blood glucose metabolism increased, especially saturated fatty acid free fat increased more obvious. Acid increased to an important role in promoting the formation of insulin resistance, in-depth study of factors of free fatty acids increased, to improve glucose metabolism and insulin resistance have important significance. Study on thyroid function in recent years, the level of thyroid hormone can affect lipid metabolism. Hypothyroidism (hypothyroidism) patients blood cholesterol levels and dyslipidemia has been recognized. Study on the effect of subclinical hypothyroidism on serum lipids alone has also shown, often accompanied by total cholesterol ( Total cholesterol, TC), low density lipoprotein cholesterol (low-density lipoprotein, cholesterol, LDL-C) and increased high density lipoprotein cholesterol (high-densitylipoprotein cholesterol, HDL-C) decreased. Recent studies have shown that the correlation between euthyriod population there are levels of thyroid hormone levels and lipids. However, no correlation between the level of thyroid hormone levels and blood free fatty acids, especially in thyroid hormone levels and blood glucose metabolism abnormal state populations of free fatty acids increased the correlation solution little. This study selected the healthy population, impaired glucose tolerance and diabetes, serum lipids, free fatty acids (FFA), thyroid hormone, glycosylated hemoglobin, fasting insulin, insulin resistance index, correlation analysis between FFA and TSH, the correlation between FFA and insulin resistance as well as TSH and bile Sterol correlation. To investigate the correlation between glucose metabolism status and serum free fatty acid and thyroid function. Methods: 75g glucose tolerance test (OGTT) were divided into normal glucose tolerance group (A group), 67 cases of abnormal glucose tolerance in 55 cases (B group), 68 patients with type 2 diabetes patients (C group), impaired fasting blood glucose (IFG) were classified as the diagnostic standard of IGT group.2 meets 1999 WHO on the diagnostic standard of diabetes. Insulin resistance index HOMA-IR= fasting blood glucose (FBG, mmol/L) * fasting insulin levels (FIns, m IU/l /22.5.) application of Elisa kit for detection of free fatty acid; application automatic biochemical detection of blood glucose, serum insulin, blood lipid indexes; thyroid hormone determination of electrochemiluminescence; glycosylated hemoglobin by high-pressure liquid chromatography. Using SPSS18.0 software to analyze the data. Results: the changes in blood of 1 diabetic patients were glycosylated related indicators 綰㈣泲鐧藉湪A緇，

本文編號：1703619