关键词: 糖尿病, 2型；甲状腺功能减退症；胰岛素样生长因子Ⅰ；胰岛素抵抗；影响因素分析

Abstract: Background　Epidemiological studies have shown that diabetic patients are more likely to develop thyroid dysfunction than ordinary people，and the incidence in female patients are higher than that in male patients.The incidence of hypothyroidism is higher than that of hyperthyroidism，and abnormal thyroid function affects glucose-lowering treatment.The diagnosis and treatment of hypothyroidism has important clinical value for diabetes mellitus，and serum insulin-like growth factor-1 （IGF-1） plays an important role in regulating thyroid hormone.Objective　To analyze the difference in IGF-1 and insulin resistance in patients with type 2 diabetes （T2DM） with hypothyroidism.Methods　A total of 100 patients with T2DM admitted to the Department of Endocrinology，North China University of Science and Technology Affiliated Hospital were chosen from August 2017 to May 2018，and 50 of them who had T2DM and hypothyroidism were selected as the observation group and another 50 patients with T2DM only as the control group.Fasting plasma glucose （FPG），2-hour postprandial glucose （PG），fasting insulin （FINS），2-hour insulin （INS），fasting C peptide，2-hour postprandial C peptide，IGF-1，serum total triiodothyronine （T3），serum total thyroxine （T4），thyroid stimulating hormone （TSH），serum free triiodothyronine （FT3），serum free thyroxine （FT4），thyroid peroxidase antibody （TPOAb），thyroglobulin antibody （TgAb），glycosylated hemoglobin （HbA1c），triacylglycerol （TG），total cholesterol （TC），high density lipoprotein （HDL），low density lipoprotein （LDL） and insulin resistance index （HOMA-IR） of the two groups were tested and compared.Results　Female，duration of diabetes，BMI，TSH，TgAb，HbA1c，TG，TC，HDL and HOMA-IR in the observation group were higher than those in the control group，and IGF-1，FT3，FT4 and LDL were lower than those in the control group （P<0.05）.IGF-1 was negatively correlated with age，duration of diabetes，BMI，TgAb and HDL and positively correlated with FPG，2-hour PG，FINS，HOMA-IR （P<0.05）.The results of unconditional two-class logistic regression analysis showed that IGF-1 〔OR=0.970，95%CI（1.954，0.988）〕，HOMA-IR 〔OR=1.342，95%CI（1.051，1.715）〕 were influential factors of T2DM with hypothyroidism （P<0.05）. Conclusion　To detect serum IGF-1 regularly in T2DM patients and evaluate degree of insulin resistance is fairly important for the diagnosis and treatment of T2DM with hypothyroidism if patients have decrease in serum IGF-1 levels and increase in insulin resistance.

Key words: Diabetes mellitus, type 2；Hypothyroidism；Insulin-like growth factor I；Insulin resistance；Root cause analysis