目的 探讨甲状腺功能正常的初诊2型糖尿病(T2DM)患者血清甲状腺激素与总胆红素(TBIL)的相关性。方法 选取280例初诊甲状腺功能正常的T2DM患者为T2DM 组,选取276例健康人为对照(NC)组,分析各组甲状腺激素水平与TBIL的相关性。结果 T2DM组血清游离T3(FT3)水平与TBIL呈正相关(r=0.512, P<0.01),游离T4(FT4)及促甲状腺激素(sTSH)与TBIL无明显相关性;NC组以上指标之间均无明显相关性。多元线性回归分析显示:在T2DM患者中,FT3与TBIL的相关性受HbA1c调控(β=0.244,P=0.02),在排除年龄、性别、血脂、丙氨酸转氨酶、乙醇摄入、BMI、空腹胰岛素影响后,这种调控作用依然存在。结论 低FT3与甲状腺功能正常的初诊T2DM患者低TBIL水平相关,此相关性受HbA1c调控;HbA1c越高,相关性越显著。这可能是高HbA1c的初诊T2DM患者容易发生动脉粥样硬化(AS)的原因之一。
Abstract
Objective To investigate the correlations between total bilirubin and thyroxine among euthyroid patients with newly diagnosed type 2 diabetes mellitus.Methods A total of 280 newly diagnosed patients with type 2 diabetes mellitus and another 276 healthy people were selected. The correlations between thyroxine and total bilirubin were analyzed.Results Bilirubin was positively correlated with free T3 in 280 T2DM subjects (r=0.512, P<0.01), but free thyroid and thyroid-stimulating hormone were not. Such correlations were not found in 276 non-diabetic subjects (r=0.086, P>0.05). During multiple linear regression analysis, free T3 was found to interact positively with the presence of HbA1c on serum bilirubin (interaction term: β=0.244, P=0.01). This interaction remained present after additional adjustment for alcohol intake, aspartate transaminase, insulin sensitivity, cholesterol, triglycerides, BMI and fasting insulin.Conclusions Low bilirubin is related to low free T3 levels in euthyroid and newly diagnosed diabetic subjects, The relationship can be modified by HbA1c. It is the possible mechanism of high atherosclerosis in newly diagnosed patients type 2 diabetes with high HbA1c.
关键词
糖尿病 /
2型 /
胆红素 /
甲状腺激素 /
动脉粥样硬化
Key words
diabetes mellitus,type 2 /
bilirubin /
thyroid hormone /
atherosclerosis
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参考文献
[1] SarfoKantanka O, Sarfo F S, Ansah E O, et al. The Effect of Thyroid Dysfunction on theCardiovascular Risk of Type 2 Diabetes Mellitus Patients in Ghana [J]. J Diabetes Res, 2018,18: 1-8.[2] Ozeki M, Morita H, Miyamura M, et al. High serum bilirubin is associated with lower prevalence of peripheral arterial disease among cardiac patients[J]. Clin Chim Acta, 2018,476: 60-66.
[3] Zhu P, Liu X, Mao X. Thyroid-Stimulating hormone levels are positively associated with insulin resistance[J]. Med Sci Monit, 2018,17:342-347.
[4] Wang C. The Relationship between type 2 diabetes mellitus and related thyroid diseases[J]. J Diabetes Res, 2013,13:1-9.
[5] Zou J, Tian F, Zhang Y, et al. Association between thyroid hormone levels and diabetic kidney disease in euthyroid patients with type 2 diabetes[J].Sci Rep, 2018,16: 4728-4737.
[6] Xu L, Lei Z, Haibing C, et al. Relationship between serum bilirubin concentrations and diabetic nephropathy in Shanghai Han’s patients with type 1 diabetes mellitus[J]. BMC Nephrol, 2017,18: 114-121.
[7] Deetman P E, Kwakernaak A J, Bakker S J, et al. Low-Normal free thyroxine confers decreased serum bilirubin in type 2 diabetes mellitus[J]. Thyroid, 2013,23: 1367-1373.
[8] Petronella E, Bakker S L, Kwakernaak A J, et al. The relationship of the anti-Oxidant bilirubin with free thyroxine is modified by insulin resistance in euthyroid subjects[J]. PLoS One, 2014,9: 90886-90892.
[9] Brian F, Christoffer C, Zhimeng Z, et al. Chemical hybridization of glucagon and thyroid hormone optimizes therapeutic impact for metabolic disease[J]. Cell, 2016,167:843-857.
[10] Bruinstroop E, Dalan R, Yang C, et al. Low dose levothyroxine reduces intrahepatic lipid content in patients with type 2 diabetes mellitus and NAFLD[J]. J Clin Endocrinol Metab, 2018,27:2698-2706.
基金
福建中医药大学校管科研基金(XB2013074)
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