本文選題：促甲狀腺激素 + 糖代謝　； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的通過(guò)比較2型糖尿病(T2DM)及其合并非酒精性脂肪性肝病(NAFLD)患者甲狀腺激素及促甲狀腺激素(TSH)水平的變化,分析非酒精性脂肪性肝病危險(xiǎn)因素——血糖、血脂、胰島素敏感性指標(biāo)變化,探討TSH水平變化對(duì)2型糖尿病合并非酒精性脂肪性肝病危險(xiǎn)因素的影響,從而對(duì)其發(fā)病機(jī)制起到一定的作用。 方法通過(guò)性別、年齡匹配,選擇我院2013年10月—2014年2月,5個(gè)月間住院T2DM合并NAFLD患者200例,女性105例,男性95例,平均年齡為(50.5±4.7)歲,根據(jù)TSH水平,將其分為5.3mIU/LTSH2.5mIU/L組(A組)100位與0.3mIU/LTSH≤2.5mIU/L組(B組)100位,入選標(biāo)準(zhǔn)：①T2DM符合世界衛(wèi)生組織(WHO)1999年的診斷標(biāo)準(zhǔn),為糖尿病的癥狀加任意時(shí)間的血漿葡萄糖均大于或等于11.1mmol/L,或者是空腹的血糖(FPG)大于或者等于7.0mmol/L,或者口服葡萄糖耐量試驗(yàn)(OGTT)餐后2小時(shí)的血糖(OGTT2hPG)大于或者等于11.1mmol/L,需要在不同時(shí)間重復(fù)確認(rèn),而且空腹指的是隔夜8-12小時(shí)內(nèi)沒(méi)有任何的熱量攝入,任意時(shí)間指的是一日內(nèi)的任何時(shí)間,不論上一次進(jìn)餐的時(shí)間以及食物的攝入量；②NAFLD診斷依照腹部的B超,標(biāo)準(zhǔn)參考的是中華醫(yī)學(xué)會(huì)2010年的非酒精性脂肪性肝病的診療指南,即NAFLD是與胰島素的抵抗和遺傳易感性相關(guān)的代謝應(yīng)激性的肝臟損傷,病理學(xué)改變與酒精性的肝病相似,但患者沒(méi)有過(guò)量飲酒和其他明確的肝損害的因素。③所有研究對(duì)象甲狀腺功能均為正常；剔除標(biāo)準(zhǔn)是：①患者使用了影響甲狀腺功能藥物的患者；②近3個(gè)月內(nèi)患有急性的疾病,嚴(yán)重的感染,創(chuàng)傷后處于應(yīng)激狀態(tài)者；③患有惡性腫瘤的患者;④有嚴(yán)重心、肝、腎臟衰竭和高血壓的患者；⑤懷孕或者正在哺乳期的婦女；⑥近期接觸了放射線者；⑦患有甲狀腺的疾病。下面的各代謝指標(biāo)：體重指數(shù)(BMI)、總膽固醇(TC)、低密度脂蛋白膽固醇(LDL-C)、甘油三酯(TG)、載脂蛋白A(Apo-A)、載脂蛋白B(Apo-B)、高密度脂蛋白膽固醇(HDL-C)、空腹的胰島素(FINS)、空腹的血糖(FBG)及胰島素抵抗指數(shù)(HoMA-IR)、胰島素敏感指數(shù)(ISI)為自變量,以不同TSH水平為應(yīng)變量作相關(guān)分析,觀察2DM合并NAFLD患者TSH水平與上述各代謝指標(biāo)的相關(guān)性。所有的正態(tài)分布計(jì)量資料采用的是均數(shù)士標(biāo)準(zhǔn)差(x士s)來(lái)表示的,非正態(tài)分布的資料經(jīng)過(guò)對(duì)數(shù)的轉(zhuǎn)換,成為正態(tài)分布的資料,正態(tài)分布的兩組比較采用t檢驗(yàn),P≤0.05為差異有統(tǒng)計(jì)學(xué)意義；相關(guān)的關(guān)系分析采用的是多元線性回歸分析,P≤0.05為有統(tǒng)計(jì)學(xué)意義 結(jié)果 1.兩組對(duì)甲狀腺素水平的影響：兩組比較,血清FT3及FT4水平變化,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 2.不同TSH水平兩組對(duì)各代謝指標(biāo)的作用比較：采用多元線性回歸分析,T2DM合并NAFLD患者列入以下指標(biāo)：TSH(Y)作為應(yīng)變量、以BMI(X1)、TG(X2)、TC(X3)、LDL-C(X4)、Apo-A(X5)、Apo-B(X6)、HDL-C(X7)、FINS(X8)、FBG(X9)、 HOMA-IR(X10),ISI(X11)為自變量,做相關(guān)性分析。結(jié)果示：TSH與BMI(X1)、TG(X3)、 LDL-C(X4)、Apo-A(X6)、Apo-B(X7)、FINS(X8)、FBG(X9)、HOMA-IR(X10)呈負(fù)相關(guān)；與HDL-C(X5),ISI(X11)呈正相關(guān)。 結(jié)論 1.2型糖尿病合并非酒精性脂肪性肝病時(shí),TSH雖在在正常范圍內(nèi),但較非2型糖尿病合并非酒精性脂肪性肝病時(shí)升高。 2.TSH對(duì)2型糖尿病合并非酒精性脂肪性肝病產(chǎn)生影響,可以使BMI、TC、TG,LDL-C,Apo-A1,Apo-B,HOMA-IR升高,使HDL-C,ISI降低；TSH通過(guò)改變2型糖尿病合并非酒精性脂肪性肝病的危險(xiǎn)因素,促進(jìn)了2型糖尿病合并非酒精性脂肪性肝病的發(fā)生及發(fā)展。
[Abstract]:Objective to compare the changes in thyroid hormones and thyroid stimulating hormone (TSH) levels in patients with type 2 diabetes (T2DM) and their combination with nonalcoholic fatty liver disease (NAFLD), and to analyze the changes in the risk factors of nonalcoholic fatty liver disease - blood glucose, blood lipid and insulin sensitivity, and to explore the changes of TSH level in the nonalcoholic type of diabetes with type 2 diabetes. The risk factors of fatty liver disease play an important role in the pathogenesis of fatty liver disease.
Methods through sex and age matching, we selected 200 cases of T2DM patients with T2DM in hospital from October 2013 to February 2014, 200 cases of hospitalized patients, 105 women and 95 males, the average age was (50.5 + 4.7) years old. According to the TSH level, they were divided into 5.3mIU/LTSH2.5mIU/L (A group) 100 and 0.3mIU/LTSH < 2.5mIU/L group (B group) 100, the criteria were: 1 T2DM character. The diagnostic standard of the WHO (WHO) 1999 is that the plasma glucose is greater than or equal to or equal to 11.1mmol/L for the symptoms of diabetes at any time, or the fasting blood glucose (FPG) is greater than or equal to 7.0mmol/L, or the oral glucose tolerance test (OGTT) 2 hours after the meal (OGTT2hPG) is greater than or equal to 11.1mmol/L. Repeated confirmation at different times, and the fasting refers to no calorie intake within 8-12 hours of the night, at any time refers to any time within one day, no matter the time of the last meal and the intake of food. (2) the NAFLD diagnosis is based on the B-ultrasound of the abdomen. The standard reference is the non-alcoholic fatty liver of the Chinese Medical Association in 2010. A guide to diagnosis and treatment of the disease, that is, NAFLD is a metabolic stress liver injury associated with insulin resistance and genetic susceptibility. Pathological changes are similar to alcoholic liver diseases, but the patients have no excessive drinking and other definite liver damage. 3. All the subjects of the study are normal; the elimination standard is: 1 patients make Patients with thyroid function drugs were used; (2) patients with acute disease, severe infection and stress in the last 3 months; (3) patients with malignant tumors; (4) patients with serious heart, liver, kidney failure and hypertension; (5) pregnant or breast feeding women; 6. The following metabolic markers: body mass index (BMI), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), apolipoprotein A (Apo-A), apolipoprotein B (Apo-B), high density lipoprotein cholesterol (HDL-C), fasting insulin (FINS), fasting blood glucose (FBG) and insulin resistance index (HoMA-IR), pancreas The island element sensitivity index (ISI) is the independent variable, and the correlation analysis is made with the different TSH level as the corresponding variable. The correlation between the TSH level of the 2DM combined with NAFLD and the above metabolic indexes is observed. All the normal distribution data are expressed by the standard deviation (x s), and the data of the non normal distribution become normal points through the logarithmic transformation. The data of cloth and two groups of normal distribution were compared by t test, and the difference was statistically significant in P < 0.05. The correlation analysis adopted multivariate linear regression analysis, and P < 0.05 was statistically significant.
Result
1. the influence of the two groups on thyroxine level: there was a significant difference in serum FT3 and FT4 levels between the two groups (P0.05).
2. the effect of different TSH level two groups on each metabolic index: using multiple linear regression analysis, T2DM combined with NAFLD patients included the following indexes: TSH (Y) as a variable, BMI (X1), TG (X2), TC (X3), pluralistic. TSH is negatively correlated with BMI (X1), TG (X3), LDL-C (X4), Apo-A (X6), Apo-B (X7), Apo-B (E), (()) and (()), and is positively correlated with (()) and (()).
conclusion
When type 1.2 diabetes is associated with nonalcoholic fatty liver disease, although TSH is in normal range, it is higher than non type 2 diabetes complicated with nonalcoholic fatty liver disease.
2.TSH has an effect on type 2 diabetes with non-alcoholic fatty liver disease, which can make BMI, TC, TG, LDL-C, Apo-A1, Apo-B, HOMA-IR increase and reduce HDL-C and ISI; TSH by changing the risk factors of type 2 diabetes with non-alcoholic fatty liver disease promotes the occurrence and development of type 2 glycan disease combined with nonalcoholic fatty liver disease.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R587.1;R575.5

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相關(guān)期刊論文 前2條

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本文編號(hào)：2068238