【摘要】：目的:探討2型糖尿病患者糖化血紅蛋白(HbA1c)與血清甲狀腺激素水平的相關(guān)性。方法:收集了2016年1月-12月在我院內(nèi)分泌科住院的2型糖尿病患者,嚴(yán)格按照納入排除標(biāo)準(zhǔn)后,共納入2型糖尿病患者648例進(jìn)行分析。記錄患者的性別、年齡、身高、體重、肝腎功能、血糖血脂、糖化血紅蛋白(Hb A1c)、游離三碘甲狀腺原氨酸(FT3)、游離甲狀腺素(FT4)、促甲狀腺素(TSH),既往史包括嚴(yán)重的心肝腎疾病、甲狀腺疾病及手術(shù)、藥物治療史等。統(tǒng)計(jì)學(xué)方法主要有獨(dú)立樣本t檢驗(yàn)、單因素方差分析或非參數(shù)秩和檢驗(yàn)進(jìn)行各個(gè)組間甲狀腺激素水平的比較,單因素相關(guān)性分析(Pearson或Spearman)分析糖化血紅蛋白及其他代謝指標(biāo)與甲狀腺激素水平的關(guān)系,在校正了混雜因素后運(yùn)用逐步多重線性回歸,探討糖化血紅蛋白與甲狀腺激素水平的相關(guān)性。結(jié)果:1、通過(guò)對(duì)收集的648例2型糖尿病患者根據(jù)2007年《中國(guó)2型糖尿病防治指南》血糖控制狀態(tài)分為HbA1c6.5%為控制良好,HbA1c6.5-7.5%為控制一般,HbA1c7.5%為控制較差,根據(jù)血糖控制情況,在所收集的病例中,僅有9.0%的患者血糖控制良好,有20.0%的患者血糖控制一般,而大部分糖尿病患者血糖控制較差,占71.0%。2、在糖尿病病程、TC、TG、LDL-C水平在三組間存在差異(P0.05),且隨著糖化血紅蛋白水平的增高,糖尿病病程、TC、TG、LDL-C水平也在增大。在性別、年齡、收縮壓、舒張壓、BMI、HDL-C水平之間三組未見(jiàn)明顯的統(tǒng)計(jì)學(xué)意義(P0.05)。在三組不同血糖控制組中,發(fā)現(xiàn)三組之間的甲狀腺抗體陽(yáng)性率及糖尿病并發(fā)癥未見(jiàn)有差別(P0.05)。3、FT3水平隨著糖尿病病程、年齡、血糖控制較差而降低(P0.01),且女性FT3水平明顯低于男性;FT4水平隨著年齡的增大而降低(P0.05),但在血糖控制較差組中明顯的高于血糖控制良好組;TSH水平在不同組中有下降趨勢(shì),但在各組中沒(méi)有統(tǒng)計(jì)學(xué)意義(P0.05)。4、HbA1c與甲狀腺激素水平的單因素性相關(guān)性分析中發(fā)現(xiàn),糖化血紅蛋白與FT3、LogTSH水平均呈負(fù)相關(guān)(r=-0.276,P0.01;r=-0.099,P0.05),而與FT4水平呈正相關(guān)(r=0.105,P0.01);多重線性回歸中,以甲狀腺激素FT3、FT4、LogTSH分別作為因變量,在校正了性別、年齡、糖尿病病程、收縮壓、舒張壓、BMI、TG、HDL、肌酐、尿酸混雜因素后,HbA1c仍與FT3水平呈負(fù)相關(guān)(t=-6.992,P=0.000);HbA1C仍與LogTSH水平呈負(fù)相關(guān)(t=-2.231,P=0.026),HbA1c仍與FT4水平呈正相關(guān)(t=2.546,P=0.011)。結(jié)論:住院2型糖尿病患者的血糖控制較差。在甲狀腺功能正常的2型糖尿病患者中,HbA1c與FT3、TSH水平呈負(fù)相關(guān),與FT4水平呈正相關(guān)。
[Abstract]:Objective: to investigate the correlation between serum thyroid hormone and glycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus. Methods: a total of 648 patients with type 2 diabetes mellitus were collected from January to December 2016, who were admitted to the Department of Endocrinology in our hospital. Gender, age, height, weight, liver and kidney function, blood glucose, blood lipid, glycosylated hemoglobin (Hb A1c), free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), were recorded. Past history includes severe heart, liver and kidney disease, thyroid disease and surgery, history of drug therapy, etc. Statistical methods included independent sample t-test, univariate ANOVA or non-parametric rank sum test to compare thyroid hormone levels among groups. Univariate correlation analysis (Pearson or Spearman) was used to analyze the relationship between glycosylated hemoglobin and other metabolic indexes and thyroid hormone levels. After adjusting for confounding factors, stepwise multiple linear regression was used. To investigate the correlation between glycosylated hemoglobin and thyroid hormone level. Results: 1. According to the status of blood glucose control of 648 patients with type 2 diabetes mellitus in China in 2007, HbA1c6.5% was classified as good control and HbA1c6.5-7.5% as general control. According to the blood sugar control condition, only 9.0% of the patients had good blood glucose control, 20.0% of the patients had moderate control of blood sugar, and most of the patients with diabetes had poor control of blood sugar. In the course of diabetes, the level of TC,TG,LDL-C was different among the three groups (P0.05), and with the increase of glycosylated hemoglobin, the level of TC,TG,LDL-C also increased in the course of diabetes. Gender, age, systolic blood pressure, diastolic blood pressure, BMI,HDL-C levels were not statistically significant (P0.05). There was no difference in positive rate of thyroid antibody and diabetic complications among the three groups (P0.05). The level of FT3 decreased with the course of diabetes, age and poor blood glucose control (P0.01). The level of FT3 in females was significantly lower than that in males. The level of FT4 decreased with the increase of age (P0.05), but it was significantly higher in the group with poor blood glucose control than that in the group with good blood glucose control. The level of TSH decreased in different groups, but there was no statistical significance in each group (P0.05). 4 the univariate correlation analysis of HbA1c and thyroid hormone levels showed that glycosylated hemoglobin (HbA1c) was associated with FT3,. The level of LogTSH was negatively correlated (r = -0.276, P 0.01). There was a positive correlation between the level of FT4 and the level of FT4 (P < 0.05), but there was a positive correlation with the level of FT4 (r = 0.105, P 0.01). In multiple linear regression, thyroid hormone FT3,FT4,LogTSH was used as dependent variable, after adjusting for sex, age, course of diabetes, systolic blood pressure, diastolic blood pressure, BMI,TG,HDL, creatinine, uric acid mixed factors. There was still a negative correlation between HbA1c and FT3 (t = -6.992, P < 0. 000). There was still a negative correlation between HbA1C and LogTSH (t = 2.231) and a positive correlation between HbA1c and FT4 (t = 2.546). Conclusion: the blood glucose control of type 2 diabetes patients in hospital is poor. In type 2 diabetes patients with normal thyroid function, HbA1c was negatively correlated with FT3,TSH and positively correlated with FT4.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.1

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