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目的 :研究血清脂联素在2型糖尿病冠心病患者甲状腺功能减退时的水平变化。方法 :选择2014年8月至2015年6月在医院就诊的2型糖尿病冠心病甲状腺正常患者60例为合并组,单纯2型糖尿病甲状腺正常60患者为单纯组,2型糖尿病冠心病甲状腺功能减退60例患者为减退组,选择同期在医院进行健康体检的60例健康体检者为对照组。收集所有入选者的临床资料,包括年龄、性别身高、体重,计算入选者的体重指数(BMI)=体重/身高2,检测四组入选者的空腹血糖(FBG)、促甲状腺激素(TSH)、糖化血红蛋白(Hb Alc)、高密度蛋白(HDL),低密度蛋白(LDL)、游离甲状腺素(FT4),游离三碘甲状腺原氨酸(FT3)、甘油三酯(TG)、总胆固醇(CHOL)、24小时尿白蛋白排泄率、脂联素、空腹胰岛素(FINS)和超敏C-RP含量,计算胰岛素抵抗指数。结果 :各组患者性别、BMI比较无差异,对照组和单纯组患者年龄比较无差异,其余各组两两比较差异有统计学意义(P<0.05);对照组Hb Alc、FBG、TG、CRP水平低于其他三组,单纯组低于合并组,对照组的HDL水平高于其他三组,差异有统计学意义(P<0.05),单纯组胰岛素抵抗指数较其他三组升高,差异有统计学意义(P<0.05),对照组FINS水平低于单纯组,高于合并组和减退组,且单纯组高于合并组和减退组,差异有统计学意义(P<0.05);减退组的TSH与其他三组比较有差异(P<0.05),合并组和减退组的FT3水平较对照组和单纯组低,差异有统计学意义(P<0.05),对照组、单纯组、合并组、减退组ADPN水平依次降低,差异有统计学意义(P<0.05);Logistic回归分析,结果显示,FBG、TSH、HDL、HOMA-IR与血浆ADPN水平有线性回归关系。结论 :血清脂联素水平越低,2型糖尿病冠心病患者甲状腺功能减退越明显,同时也是影响冠心病的发生和进展的重要因素,可以作为2型糖尿病冠心病患者甲状腺功能减退的敏感指标。
Objective: To investigate the level of serum adiponectin in patients with type 2 diabetes with coronary heart disease hypothyroidism. Methods: From August 2014 to June 2015, 60 patients with type 2 diabetes mellitus with coronary heart disease and thyroid normal in type 2 diabetes mellitus were enrolled. Patients with type 2 diabetes mellitus were divided into simple group (n = 60) and type 2 diabetic patients with hypothyroidism 60 patients were hypogonadal group, select the same period in the hospital for physical examination of 60 cases of healthy people as the control group. Clinical data including age, sex, height and weight of all participants were collected and BMI = body weight / height was calculated. The fasting blood glucose (FBG), thyrotropin (TSH) Hb Alc, HDL, FTL, FT4, TG, CHOL (total cholesterol (CHOL) ), 24-hour urinary albumin excretion rate, adiponectin, fasting insulin (FINS) and high-sensitivity C-RP content were calculated to calculate the index of insulin resistance. Results: There was no significant difference in gender and BMI between the two groups. There was no difference in the age between the control group and the simple group (P <0.05), but there was significant difference between the other groups (P <0.05) The level of HDL in the simple group was lower than that in the other three groups, and the level of HDL in the control group was higher than the other three groups (P <0.05). The index of insulin resistance in the simple group was higher than the other three groups (P <0.05). The FINS level in the control group was lower than that in the simple group and higher than that in the combined group and the diminished group, and the difference between the simple group and the diminished group was statistically significant (P <0.05) (P <0.05). The levels of FT3 in the combined group and the diminished group were lower than those in the control group and the simple group (P <0.05). The levels of FT3 in the control group, the simple group, the combined group (P <0.05). Logistic regression analysis showed that there was a linear regression relationship between FBG, TSH, HDL, HOMA-IR and plasma ADPN levels. Conclusions: The lower serum adiponectin level is associated with an obvious hypothyroidism in patients with type 2 diabetes mellitus and is also an important factor influencing the occurrence and progression of coronary heart disease. It may serve as a sensitive indicator of hypothyroidism in patients with type 2 diabetes mellitus.