摘要
目的探讨甲状腺功能正常的2型糖尿病(type 2 diabetes mellitus,T2DM)患者中甲状腺激素敏感性与25-羟基维生素D[25-hydroxyvitamin D,25(OH)D]水平的相关性。方法纳入2023年1月至2024年8月在安徽省第二人民医院内分泌科就诊的T2DM患者267例,根据25(OH)D水平分为T2DM+VD非缺乏组(n=80)和T2DM+VD缺乏组(n=187),并选取同期健康体检者30例作为健康对照组(NC组)。测定各组生化指标和甲状腺功能,并计算出甲状腺激素敏感性相关指数,包括促甲状腺素抵抗指数(thyrotroph thyroxine resistance index,TT4RI)、促甲状腺激素指数(TSH index,TSHI)、甲状腺反馈分位数指数(thyroid feedback quantile index,TFQI)、参数甲状腺反馈分位数指数(parametric thyroid feedback quantile-based index,PTFQI)以及FT_(3)/FT_(4)比值。结果T2DM+VD缺乏组FBG、TyG指数、TT4RI、TSHI、PTFQI、TFQI高于T2DM+VD非缺乏组(P<0.05),FT_(3)/FT_(4)低于T2DM+VD非缺乏组(P<0.05);与NC组相比,T2DM+VD缺乏组和T2DM+VD非缺乏组患者的TT4RI、TSHI、TFQI、PTFQI呈不同程度的升高(P<0.05),25(OH)D与FT_(3)/FT_(4)呈不同程度的降低(P<0.05)。Pearson相关性分析显示,25(OH)D与FBG、HbA1c、TyG指数、LDL呈负相关(P<0.05),与TT4RI、TSHI、TFQI、PTFQI亦呈负相关(P<0.05),而25(OH)D与FT_(3)/FT_(4)呈正相关(P<0.05)。Logistic回归分析结果显示,高TT4RI[OR(95%CI)=1.786(1.062~3.121),P=0.024]、高TSHI[OR(95%CI)=1.921(1.425~3.298),P=0.024]、高TFQI[OR(95%CI)=1.962(1.448~3.116),P=0.016]、高PTFQI[OR(95%CI)=1.854(1.165~3.019),P=0.023]以及低FT_(3)/FT_(4)[OR(95%CI)=0.819(0.628~0.973),P=0.002]与T2DM患者维生素D缺乏的风险增加显著相关。结论在甲状腺功能正常的T2DM患者中,甲状腺激素敏感性受损与25(OH)D水平降低存在显著相关性,提示维生素D可能在甲状腺激素敏感性的调节以及T2DM患者的糖脂代谢中发挥重要作用。
Objective This study aimed to investigate the correlation between thyroid hormone sensitivity and 25-hydroxyvitamin D[25(OH)D]levels in patients with type 2 diabetes mellitus(T2DM)who have normal thyroid function.Methods In this cohort study,267 patients with type 2 diabetes who were admitted to the Department of Endocrinology of Anhui No.2 Provincial People’s Hospital from January,2023 to August,2024 were divided into a T2DM+VD non-deficient group(n=80)and a T2DM+VD deficient group(n=187)according to 25(OH)D levels,while 30 healthy subjects were selected as the healthy control group(NC group).The biochemical indexes and thyroid function of each group were measured,and the related parameters of thyroid hormone sensitivity were calculated,including:thyrotroph thyroxine resistance index(TT4RI),TSH index(TSHI)and thyroid feedback quantile index,(TFQI),parametric thyroid feedback quantile-based index(PTFQI),and FT_(3)/FT_(4).Results FBG,TyG index,TT4RI,TSHI,PTFQI and TFQI in T2DM+VD deficient group were significantly higher than those in T2DM+VD non-deficient group(P<0.05),while FT_(3)/FT_(4)in T2DM+VD deficient group was significantly lower than those in T2DM+VD non-deficient group(P<0.05).Compared with the NC group,TT4RI,TSHI,TFQI and PTFQI of the T2DM+VD deficient group and the T2DM+VD non-deficient group were significantly increased with various degrees(P<0.05),while 25(OH)D and FT_(3)/FT_(4)were significantly decreased with various degrees(P<0.05).Pearson correlation analysis showed that 25(OH)D was negatively correlated with FBG,HbA1c,TyG index and LDL(P<0.05),as well as TT4RI,TSHI,TFQI and PTFQI(P<0.05),while 25(OH)D was positively correlated with FT_(3)/FT_(4)(P<0.05).Logistic regression analysis showed that high TT4RI[OR(95%CI)=1.786(1.062-3.121),P=0.024],high TSHI[OR(95%CI)=1.921(1.425-3.298),P=0.024],high TFQI[OR(95%CI)=1.962(1.448-3.116),P=0.016],high PTFQI[OR(95%CI)=1.854(1.165-3.019),P=0.023]and low FT_(3)/FT_(4)[OR(95%CI)=0.819(0.628-0.973),P=0.002]were associated with an increased risk of VD deficiency associated with T2DM.Conclusion In patients with euthyroid Type 2 Diabetes Mellitus,impaired thyroid hormone sensitivity is significantly associated with reduced 25(OH)D levels,suggesting that vitamin D could play an important role in the regulation of thyroid hormone sensitivity.
作者
王萍
王文平
丁晓洁
张永明
陈逸青
WANG Ping;WANG Wenping;DING Xiaojie;ZHANG Yongming;CHEN Yiqing(Department of Endocrinology,Anhui Second Provincial People’s Hospital,Hefei 230041,China;Department of Endocrinology,The First Affiliated Hospital of Anhui Medical University,Hefei 230031,China)
出处
《标记免疫分析与临床》
2025年第6期1201-1207,共7页
Labeled Immunoassays and Clinical Medicine
基金
安徽省教育厅自然科学研究重点项目(编号:2023AH053385)
安徽省自然科学基金青年项目(编号:2208085QH242)
安徽省人力资源和社会保障厅出国留学人员重点项目(编号:2020LCX003)。
关键词
2型糖尿病
甲状腺激素敏感性
维生素D
Type 2 diabetes mellitus
Thyroid hormone sensitivity
Vitamin D
作者简介
通信作者:陈逸青。E-mail:chenyiqing0107@163.com。
