初诊2型糖尿病患者正常范围甲状腺功能状态的临床分析

目的了解正常范围甲状腺功能状态与2型糖尿病的关系。方法选取甲状腺功能正常的初诊2型糖尿病患者156例，检测空腹血糖、糖化血红蛋白、胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹胰岛素浓度，计算稳态模型胰岛素抵抗指数、体重指数，分析血清促甲状腺激素（TSH）、FT3、FT4与上述指标的相关性。将测得TSH值，按四分位法分为低水平组和高水平组，比较组间各指标的差异。结果正常范围内血清TSH水平与体重指数显著正相关，与胰岛素抵抗指数、糖化血红蛋白、甘油三酯呈正相关。TSH高水平组（TSH3．5—4．6mIU／L）患者的体重指数、空腹胰岛素、胰岛素抵抗指数、糖化血红蛋白及甘油三酯均较TSH低水平组（TSH0．3～1．4mIU／L）明显增高（P〈0．05）。结论2型糖尿病患者正常范围的甲状腺功能状态下，高水平的TSH对糖脂代谢紊乱、体重增加及胰岛素抵抗有一定影响，临床不容忽视。

Clinical analysis of thyroid function of normal range state in patients with new type 2 diabetes

Objective Understand the normal range thyroid function state and type 2 diabetes relationship. Methods Select 156 new cases of type 2 diabetes patients with the normal thyroid function, detect fasting plasma glucose （FPG） and glycated hemoglobin （ HbA1 c ）, cholesterol （ TC ）, triglyceridcs （TG）, high-density lipoprotein cholesterol （ HDL-C）, low density lipoprotein cholesterol （ LDL-C ）, fasting insulin（Fins） ,calculate steady model insulin resistance index（ HOMA-IR）, body mass index（BMI）, analysis serum TSH ,FT3 ,FT4 and the above index of relevancy. According to the quarterback method TSH is divided into low level group and the high level group, compare the difference of each index between groups. Results Serum TSH level within the normal range is positively related significantly to BMI, and is positively correlative with HOMA-IR, HbA1 c and TG. BMI, Fins, HOMA-IR, HbA1 c and TG of high TSH level group（ TSH 3.5 - 4.6 mIU/L） are increased significantly than low TSH level group（ TSH 0.3 - 1.4 mIU/L,P 〈 0.05 ）. Conclusion For patients with type 2 diabetes, the normal range of thyroid function has certain influence to glucolipid metabolism ,weight and insulin resistance,which should not be ignored.