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目的检测无代谢综合征组分的体检人群人成纤维细胞生长因子21(FGF21)水平、脂代谢、糖代谢相关指标及促甲状腺激素(TSH)水平,探讨FGF21与TSH的相关性。方法收集2012年10月—2013年4月北京大学第一医院体检人群中无任何代谢综合征组分,无糖尿病、高血压、慢性肾脏病、多囊卵巢综合征、自身免疫性疾病及垂体和下丘脑疾病病史者356例,记录年龄、性别,测量身高、体质量、腰围、臀围、血压、体脂含量,检测空腹血浆血肌酐(Scr)、尿酸(UA)、空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,检测空腹血清胰岛素(FINS)、TSH、甲状腺球蛋白抗体(Tg Ab)、甲状腺过氧化物酶抗体(TPOAb)、FGF21、游离脂肪酸(FFA)水平。计算体质指数(BMI)、腰臀比、稳态模型评估胰岛素抵抗指数(HOMA-IR)。结果 356例无代谢综合征组分者TSH 0.00~12.08 m U/L,其中TSH降低组(<0.55 m U/L)8例,TSH正常组(0.55~4.78 m U/L)320例,TSH升高组(>4.78 m U/L)28例;Tg Ab、TPOAb任一阳性组75例,Tg Ab和TPOAb均阴性组280例。FGF21 0~1 757 ng/L,FGF21水平与腰围(r=0.110,P=0.038)、腰臀比(r=0.119,P=0.025)、TC(r=0.113,P=0.012)、LDL-C(r=0.175,P=0.001)呈极弱正相关,FGF21水平与年龄(r=0.324,P<0.001)、TG(r=0.302,P<0.001)呈低度正相关。多元线性逐步回归分析结果显示,TG与FGF21独立相关(P<0.001),标准化回归方程为:Y_(FGF21)=230.84X_(TG)+5.26X_(年龄)。TSH水平与Tg Ab(r=0.147,P=0.006)、TPOAb(r=0.168,P=0.001)呈极弱正相关;TSH水平与FFA(r=0.840,P<0.001)呈高度正相关。TSH降低组、TSH正常组、TSH升高组FFA水平比较,差异有统计学意义(P<0.05);其中TSH正常组、TSH升高组FFA水平高于TSH降低组(P<0.05);TSH升高组FFA水平高于TSH正常组(P<0.05)。Tg Ab、TPOAb任一阳性组FGF21水平为〔331(314)ng/L〕,Tg Ab和TPOAb均阴性组FGF21水平为〔318(324)ng/L〕,差异无统计学意义(Z=-0.311,P=0.755)。结论在无代谢综合征组分的体检人群中,FGF21可能与TSH不相关,且其可能与甲状腺自身免疫无关。
Objective To detect the levels of human fibroblast growth factor 21 (FGF21), lipid metabolism, glucose metabolism and thyroid stimulating hormone (TSH) levels in physical examination population without metabolic syndrome and to explore the correlation between FGF21 and TSH. Methods Collecting from October 2012 to April 2013, no metabolic syndrome component, no diabetes, high blood pressure, chronic kidney disease, polycystic ovary syndrome, autoimmune diseases and pituitary gland in the physical examination population of Peking University First Hospital 356 patients with hypothalamic disease history were recorded age, sex, height, body weight, waist circumference, hip circumference, blood pressure, body fat content, fasting plasma levels of serum creatinine, uric acid, fasting blood glucose, Triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting serum insulin (FINS), TSH, thyroglobulin antibody (Tg Ab), thyroid peroxidase antibody (TPOAb), FGF21, free fatty acid (FFA) levels. Body mass index (BMI), waist-to-hip ratio, and homeostasis model assessment of insulin resistance index (HOMA-IR) were calculated. Results Among the 356 patients without metabolic syndrome, TSH ranged from 0.00 to 12.08 mU / L, including 8 in TSH reduced group (<0.55 mU / L), 320 in TSH normal group (0.55 ~ 4.78 mU / L) There were 28 cases in the elevated group (> 4.78 mU / L); 75 cases in any of the Tg Ab and TPOAb positive groups, and 280 in the negative group of Tg Ab and TPOAb. (P = 0.012), waist circumference (r = 0.119, P = 0.025), TC (r = 0.113, P = 0.012), LDL-C (r = 0.175, P = 0.001). There was a low positive correlation between FGF21 level and age (r = 0.324, P <0.001) and TG (r = 0.302, P <0.001) Multivariate linear stepwise regression analysis showed that TG was independently associated with FGF21 (P <0.001). The standardized regression equation was: Y FGF21 = 230.84X TG + 5.26X. TSH levels showed a very weak positive correlation with Tg Ab (r = 0.147, P = 0.006) and TPOAb (r = 0.168, P = 0.001). TSH levels were positively correlated with FFA (r = 0.840, P <0.001). TSH decreased group, TSH normal group, TSH increased group FFA levels, the difference was statistically significant (P <0.05); TSH normal group, TSH elevated group FFA level was higher than TSH reduced group (P <0.05); TSH Elevated FFA levels were higher than the normal TSH group (P <0.05). The level of FGF21 was (331 (314) ng / L in either of the positive and negative Tg Ab and TPOAb groups), and the level of FGF21 in both Tg Ab and TPOAb negative groups was [318 (324) ng / L] 0.311, P = 0.755). Conclusion FGF21 may not be related to TSH in the physical examination population without metabolic syndrome and may not be related to thyroid autoimmunity.