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目的探讨T2DM患者血清促甲状腺激素(TSH)水平与胰岛β细胞功能的关系。方法甲状腺功能正常的T2DM患者524例,根据其TSH四分位水平分为4组。稳态模型评估法比较各组间胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)和其他生化指标。结果 Q4组HOMA-β明显高于其他3组,而HbA1c、糖化血清蛋白(GA)明显低于其他3组,但4组间HOMA-IR差异无统计学意义。相关分析显示,HOMA-β与BMI、ΔC-P及TSH等呈正相关,与HbA1c及GA呈负相关。多元逐步回归分析则表明,BMI、TSH和HbA1c是HOMA-β的独立影响因素。女性T2DM患者TSH明显高于男性,且绝经后女性TSH水平明显高于绝经前。多元逐步回归分析表明,性别是TSH的独立影响因素。结论血清TSH与HOMA-β相关,正常范围内高水平的血清TSH提示患者有较好的胰岛β细胞功能,且TSH存在性别差异。
Objective To investigate the relationship between serum thyrotropin (TSH) levels and pancreatic β-cell function in T2DM patients. Methods 524 T2DM patients with normal thyroid function were divided into 4 groups according to their TSH quartiles. The steady-state model assessment method was used to compare the HOMA-β, HOMA-IR and other biochemical indexes among groups. Results The HOMA-β in Q4 group was significantly higher than that in the other three groups, while the levels of HbA1c and GA in the Q4 group were significantly lower than those in the other three groups. However, there was no significant difference in the HOMA-IR between the four groups. Correlation analysis showed that HOMA-β was positively correlated with BMI, ΔC-P and TSH, but negatively correlated with HbA1c and GA. Multiple stepwise regression analysis showed that BMI, TSH and HbA1c were independent factors of HOMA-β. TSH in women with T2DM was significantly higher than that in men, and TSH levels in postmenopausal women were significantly higher than in premenopausal women. Multiple stepwise regression analysis showed that sex was an independent factor of TSH. Conclusion Serum TSH is associated with HOMA-β. High levels of serum TSH in the normal range suggest that patients have better pancreatic β-cell function, and there is a gender difference in TSH.