本文關(guān)鍵詞：甲狀腺功能與肥胖及代謝綜合征的相關(guān)性研究，由筆耕文化傳播整理發(fā)布。

        研究背景近年來,隨著全球經(jīng)濟(jì)的快速發(fā)展,人們物質(zhì)生活水平的提高,肥胖的發(fā)病率逐年增加,已成為危害人類健康的世界性問題之一。作為一種慢性代謝性疾病,其特點為幾種代謝成分異常聚集的病理狀態(tài),是一組復(fù)雜的代謝紊亂癥候群。目前大量的臨床研究發(fā)現(xiàn),肥胖與甲狀腺功能的變化存在一定關(guān)系,甲狀腺激素水平的變化可作為體重變化的預(yù)測指標(biāo),為肥胖的治療提供新的思路。目的探討甲狀腺功能與肥胖及代謝綜合征各組分間的相關(guān)性。方法以山東濟(jì)南重汽集團(tuán)社區(qū)門診及齊魯醫(yī)院查體中心33-71歲自然人群共896例為調(diào)查對象,選取BMI≥25.Okg/m2的158例肥胖人群,其中男70例(44.3%),女88例(55.7%)18.5kg/m2≤BIM≤24kg/m2的120例正常人群進(jìn)入該研究,其中男60例(50.0%),女60例(50.0%),平均年齡53.83±12.77歲。所有調(diào)查對象均自愿參加,并簽署知情同意書,有經(jīng)過統(tǒng)一培訓(xùn)合格人員采取統(tǒng)一調(diào)查問卷對調(diào)查人員進(jìn)行詢問調(diào)查,體格檢查及實驗室檢查。采用SPSS13.0軟件進(jìn)行統(tǒng)計分析,計量資料用均數(shù)±標(biāo)準(zhǔn)差(x±S)表示,組間比較用t檢驗,以P<0.05為差異有統(tǒng)計學(xué)意義。結(jié)果肥胖組、MS組與正常人群組基線值無統(tǒng)計學(xué)差異,可比性良好。①單純肥胖與正常人群比較：與正常人群比較,單純肥胖者(以BMI計算)收縮壓和舒張壓均增高,并有統(tǒng)計學(xué)差異(P<0.05)；肥胖者血清胰島素、C-肽和糖化血紅蛋白水平均高于正常對照組(分別為p<0.001和p<0.05);肥胖患者甲狀腺功能指標(biāo)中游離甲狀腺素(free T4, FT4)和促甲狀腺激素(thyroid stimulating hormone, TSH)血清濃度增加,有非常顯著性差異(P<0.01)；而游離三碘甲腺原氨酸(freeT3,FT3)水平雖然有下降趨勢,但與正常組比較無統(tǒng)計學(xué)差異(P>0.05)；肥胖者HDL-C濃度水平顯著低于正常人群(P<0.01)；TG無統(tǒng)計學(xué)差異(P>0.05)。②符合CDS2004診斷標(biāo)準(zhǔn)MS與正常人群比較：與正常人群相比,MS患者在血壓(收縮壓和舒張壓)、BMI、血清胰島素、C-肽和糖化血紅蛋白水平均顯著升高(分別為P<0.01和P<0.001)；而且,血脂水平(HDL-C、TG、CHO)和甲狀腺功能三項指標(biāo)均有統(tǒng)計學(xué)差異(P<0.01)。③符合2007《中國成人血脂異常防治指南》診斷標(biāo)準(zhǔn)MS與正常人群比較：與正常人群相比,MS患者在血壓(收縮壓和舒張壓)、BMI、血清胰島素、C-肽和糖化血紅蛋白水平均顯著升高(分別為P<0.05,P<0.01和P<0.001)；而血脂水平(HDL-C、TG)和甲狀腺功能三項指標(biāo)均有統(tǒng)計學(xué)差異(分別為P<0.05,P<0.01和P<0.001)。④TSH與代謝綜合征各組分間的Pearson相關(guān)性：在肥胖人群,TSH與收縮壓呈正相關(guān)(◇p<0.05),與血漿胰島素水平呈負(fù)相關(guān)(◆p<0.05)、與C-肽呈負(fù)相關(guān)(P>0.05)；正常體重人群,TSH與腰臀比、膽固醇呈正相關(guān)(’p,’p<0.05),與胰島素、C-肽呈負(fù)相關(guān)(P>0.05)。結(jié)論無論按照CDS2004標(biāo)準(zhǔn)還是按照2007《中國成人血脂異常防治指南》對MS進(jìn)行診斷,MS患者與正常人群相比,甲狀腺功能三項指標(biāo)FT3、FT4和TSH均存在顯著差異(分別為P<0.05、P<0.01、P<0.001),即使是肥胖或超重患者與正常人群相比,甲狀腺功能中的FT4和TSH也存在統(tǒng)計學(xué)差異(P<0.01),在MS或肥胖患者FT4和TSH有明顯的升高趨勢,而FT3有降低趨勢,提示甲狀腺功能狀況可能與MS的發(fā)生或發(fā)展存在一定的關(guān)系,MS患者可能存在甲狀腺功能減低或甲狀腺激素抵抗現(xiàn)象。

    BackgroundIn the past decades, with the rapid development of economy and the improvement of people’s living standard day by day, a dramatic increased incidence of obesity has been attached overwhelmingly threatening people’s health, which has become a major global health concern. As a chronic metabolic disease, metabolic syndrome is characterized by an aggregation of multiple impaired metabolic components including obesity, hyperinsulinemia, hyperglycemia, hyperlipidemia, hyperuricemia as well as hypertension, which forms an intricate complex of metabolic disorder. Thyroid function, which has been observed to be closely associated with obesity for decades, is now again attracting more attentions of investigators since its intricate mechanisms underlying especially the findings of the novel independent role of thyroid stimulating hormone in adipocytes and obesity associated cardiovasculopathy were further revealed. Alternation in serum thyroid hormones levels especially the thyroid stimulating hormone levels can be referred as a prognostic indicator of metabolic syndrome. And the further study of the exact roles of thyroid hormones in obesity, would undoubtly provide novel insights into the understanding of the pathogenesis as well as the intervention strategies of obesity and its associated metabolic syndrome.ObjectiveTo evaluate the correlativity between serum thyroid hormones levels and the components of metabolic syndrome in euthyroid patients with morbid obesity MethodsIn this randomized, double-blinded study, a subcohort of158people with obesity (BMI≥25. Okg/m2with70male and88female),120people as health controls (18.5kg/m2BIM≤24kg/m2,with60male and60female) were randomly enrolled from a cohort of896people who took part in the routine medical checkup in community clinics of CNHTC JINAN TRUCK CO., LTD and Health examination center of Qilu Hospital of Shandong University. The average age of the participants is64+10years. Before performing the study, we explain the procedure in detail and obtain written informed consent from each participant. A detailed clinical questionnaire was also obtained from each patient including record of history of disease, physical and laboratory examinations by well trained professionals. Statistical procedures were performed with the statistical package PASW13.0. data were represented as Mean+SD (X±S). The Pearson or Spearman correlation test was used for correlation analysis depending on data distribution. Significance is defined as a two tailed P<0.05.ResultsThe demographic baseline parameters has no statistical significant difference among the three groups of participants,①compared with health controls, patients with obesity (defined as BMI≥25.0kg/m2) has significantly elevated systolic blood pressures and diastolic pressures (P<0.05); the levels of serum insulin, C-peptide as well as Hbl Ac are all higher in obese patients than those of health controls (p<0.001and p<0.05respectively). The serum levels of free T4(FT4) and thyroid stimulating hormone (TSH) was increased in euthyroid obese patients and statistically different (P<0.01).However, as for serum levels of free T3(FT3), there is a declining tedency in obseity, but in our present study, the difference is not statistically significa(P>0.05). Serum levels of High-density lipoprotein cholesterol ester (HDL-C) are significantly decreased in obese patients compared with health controls (P<0.01). But the increase in triglycerides are not statistically signifcant in our study (P>0.05).②compared with health people, patients with metabolic syndrome (MS) defined by diagnostic criteria made by Chinese Diabetes Society2004(CDS2004) have significantly elevated levels of blood pressures, body mass index (BMI)(P<0.01), serum insulin (P<0.01), serum C-peptide(P<0.01) and HblAc(P<0.01)。Furthermore, Both the serum lipid (including HDL-C(P<0.01), TG (P<0.01)and total cholesterol(P<0.01)) and the parameters of thyroid function (including TSH, FT4and FT3) reveal significant difference between patients with metabolic syndrome and health people (P<0.01)。③ompared with health people, patients with metabolic syndrome (MS) defined by diagnostic criteria from "Chinese guideline for prevention and treatment of adult dyslipidemia2007", again have significantly elevated levels of blood pressures, body mass index (BMI)(P<0.01), serum insulin (P<0.001), serum C-peptide (P<0.01) and HblAc (P<0.01)。Furthermore, Both the serum lipid (including HDL-C,TG and total cholesterol) and all the three parameters of thyroid function (including TSH (p<0.05), FT4(p<0.01) and FT3(P<0.05)) reveal significant difference between patients with metabolic syndrome and health people (P<0.01) as well。④The correlation study between serum TSH levels and each component of metabolic syndrome reveals significant positive relevance of serum levels of TSH with systolic blood pressures (p<0.05) and significant negative relevance of serum TSH levels with both insulin (p<0.05) and C-peptide (p<0.05) levels in obese patients. In lean health people, the significant positive correlation between serum TSH levels and WHR as well as cholesterol is revealed. Again serum TSH levels are negatively correlated with serum levels of both insulin (p<0.05) and C-peptide (p<0.05)ConclusionIn conclusion, Patients with metabolic syndrome, according to diagnostic criteria formulated by both CDS2004and Chinese guidelines on prevention and treatment of dyslipidemia in adults (2007), has a significant different serum levels of all the three parameters(FT3, FT4, TSH) of thyroid function(with respectively P<0.05、P<0.01、 P<0.001). Significantly elevated serum levels of FT4, together with TSH, was also observed in patients with obesity compared with lean health controls. Taken together, our study implicate that the function status of thyroid hormones may be closely linked to obesity as well as the obesity associated metabolic syndrome. Declined FT3, together with elevated FT4and TSH, may have a role in the pathogenesis of obesity as well as disease progression from obesity into metabolic syndrome.

甲狀腺功能與肥胖及代謝綜合征的相關(guān)性研究

中文摘要6-9ABSTRACT9-12符號說明13-16前言16-18資料與方法18-23結(jié)果23-26討論26-32總結(jié)32-34結(jié)論34-35附圖表35-36參考文獻(xiàn)36-43致謝43-44攻讀碩士學(xué)位期間發(fā)表的學(xué)術(shù)論文目錄44-45學(xué)位論文評閱及答辯情況表45

  本文關(guān)鍵詞：甲狀腺功能與肥胖及代謝綜合征的相關(guān)性研究，，由筆耕文化傳播整理發(fā)布。