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

摘要： 背景　流行病学研究显示糖尿病患者甲状腺功能异常患病率显著高于普通人群，且女性高于男性患者，合并甲状腺功能减退症发生率高于甲状腺功能亢进症，甲状腺功能异常影响降糖治疗的效果，甲状腺功能减退症的诊治在糖尿病中有重要临床价值。血清胰岛素样生长因子1（IGF-1）是重要的甲状腺激素调节因子。目的　分析2型糖尿病（T2DM）合并甲状腺功能减退症患者的IGF-1及胰岛素抵抗的差异。方法　选取2017年8月—2018年5月华北理工大学附属医院内分泌科住院的T2DM患者100例，将T2DM合并甲状腺功能减退症患者50例作为观察组，单纯T2DM患者50例作为对照组。测定并比较两组空腹血糖（FPG）、餐后2 h血糖（2 hPG）、空腹胰岛素（FINS）、餐后2 h胰岛素（2 hINS）、空腹C肽、餐后2 hC肽、IGF-1、三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）、糖化血红蛋白（HbA1c）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）以及胰岛素抵抗指数（HOMA-IR）。结果　观察组女性、糖尿病病程、体质指数（BMI）、TSH、TgAb、HbA1c、TG、TC、HDL、HOMA-IR均高于对照组，IGF-1、FT3、FT4、LDL均低于对照组（P<0.05）。IGF-1与年龄、糖尿病病程、BMI、TgAb、HDL呈负相关，与FPG、2 hPG、FINS、HOMA-IR呈正相关（P<0.05）。非条件二分类Logistic回归分析结果显示，IGF-1〔OR=0.970，95%CI（0.954，0.988）〕、HOMA-IR〔OR=1.342，95%CI（1.051，1.715）〕是T2DM合并甲状腺功能减退症的影响因素（P<0.05）。结论　T2DM合并甲状腺功能减退症患者血清IGF-1水平降低、胰岛素抵抗加重，定期检测T2DM患者血清IGF-1并评估胰岛素抵抗程度对T2DM合并甲状腺功能减退症诊断及治疗尤为重要。

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