住院2型糖尿病患者甲状腺激素水平的分析(2)
近年来研究发现，甲状腺素能诱导LDL-C受体信使核糖核酸(mRNA)水平增加，使LDL-C受体数目增加和活性增高，从而降低LDL-C和TG水平，低甲状腺激素患者较正常人群更易形成动脉硬化的脂谱改变，具体表现为血甘油三酯、低密度脂蛋白胆固醇水平较正常者明显升高[5] 。血清TSH水平与HDL-C水平负相关，与其他血脂水平正相关，在胰岛素敏感指数低者TSH与血脂的上述关系加强[6]。故TSH增高、FT4降低增加心血管疾病的风险，进而促进糖尿病及其并发症的发展。本研究结果发现FT4与TG呈负相关 ，与HDL-C呈正相关；TSH与TG呈正相关。TG(X1)、BUN(X2)与FT4(Y)独立相关；TG(X)与TSH(Y)的独立相关,与报道一致。但本研究中未发现LDL-C与甲状腺激素间有相关性，可能与入组的2型糖尿病病人多合并大血管病变和脂代谢异常而常规应用了他汀类药物治疗影响有关。另外，本研究结果还显示BUN与FT4独立相关，考虑可能与甲状腺素加速代谢促进蛋白质分解大于合成致负氮平衡有关。
综上所述，糖尿病患者甲状腺激素水平变化与糖尿病病情密切相关，应在糖尿病患者中重视甲状腺疾病的筛查，甲状腺功能水平对糖尿病病情的评估、预后的判断以及并发症的防治，具有重要的临床意义。
参考文献
[1] Vondra K,Vrbikova J,Dvorakova K.Thyroid gland diseases in adult patients with diabetes mellitus.Minerva Endocrinol,2005,30:217-236.
[2] 董如娇，张宏.糖尿病合并甲状腺异常的研究进展.国外医学内分泌分册，2005，25:388-390.
[3] Mora C,Navarro JF.The role of inflammation as a pathogenic factor in the development of renal diabetes.Curr Diab Rep,2005,5:399-401.
[4] Lu L,Zhang Q,Pu LJ,et al.Elevation of tumor necrosis factor-alpha, interleukin-1beta and interleukin-6 level in aortic intima of Chinese Guizhou minipigs with streptozotocininduced diabetes.Chin Med J(Engl),2007,120: 479-484.
[5]Iadecola C. Neurovascular regulation in the normal brain and in Alzheimer’s disease J. Nat Rev Neurosci. 2004, 5,5:347-360.
[6]Lu L,Zhang Q,Pu LJ,et al.Elevation of tumor necrosis factor-alpha,interleukin- 1beta and interleukin-6 level in aortic intima of Chinese Guizhou minipigs with streptozotocininduced diabetes.Chin Med J(Engl),2007,120:479-484., http://www.100md.com(周丽 高政南 谷晓岚)
综上所述，糖尿病患者甲状腺激素水平变化与糖尿病病情密切相关，应在糖尿病患者中重视甲状腺疾病的筛查，甲状腺功能水平对糖尿病病情的评估、预后的判断以及并发症的防治，具有重要的临床意义。
参考文献
[1] Vondra K,Vrbikova J,Dvorakova K.Thyroid gland diseases in adult patients with diabetes mellitus.Minerva Endocrinol,2005,30:217-236.
[2] 董如娇，张宏.糖尿病合并甲状腺异常的研究进展.国外医学内分泌分册，2005，25:388-390.
[3] Mora C,Navarro JF.The role of inflammation as a pathogenic factor in the development of renal diabetes.Curr Diab Rep,2005,5:399-401.
[4] Lu L,Zhang Q,Pu LJ,et al.Elevation of tumor necrosis factor-alpha, interleukin-1beta and interleukin-6 level in aortic intima of Chinese Guizhou minipigs with streptozotocininduced diabetes.Chin Med J(Engl),2007,120: 479-484.
[5]Iadecola C. Neurovascular regulation in the normal brain and in Alzheimer’s disease J. Nat Rev Neurosci. 2004, 5,5:347-360.
[6]Lu L,Zhang Q,Pu LJ,et al.Elevation of tumor necrosis factor-alpha,interleukin- 1beta and interleukin-6 level in aortic intima of Chinese Guizhou minipigs with streptozotocininduced diabetes.Chin Med J(Engl),2007,120:479-484., http://www.100md.com(周丽 高政南 谷晓岚)