| 魏灵荣,王蔚陆,王屹,高冰,姜天乐,云虹.基于亚组分析探讨糖脂代谢对甲状腺结节的影响[J].中国临床保健杂志,2024,(1):70-79. |
| 基于亚组分析探讨糖脂代谢对甲状腺结节的影响 |
| Study on the subgroup analysis of the effect of glucose-lipid metabolism on thyroid nodules of physical examination group |
| 投稿时间：2024-01-20 |
| DOI：10.3969/J.issn.1672-6790.2024.01.015 |
| 中文关键词: 甲状腺结节 脂代谢障碍 葡萄糖代谢障碍 危险因素 |
| 英文关键词: Thyroid nodule Lipid metabolism disorders Glucose metabolism disorders Risk factors 〖FL |
| 基金项目: |
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| 中文摘要: |
| 目的 将体检者划分不同亚组,阐释糖脂代谢对甲状腺结节(TN)的影响。方法 选取2018年1月至2023年10月在北京大学医院体检的有甲状腺B超检查和总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血葡萄糖(GLu)资料的人群。首先比较TN阳性和甲状腺未见明显异常者的糖脂代谢指标,结合性别、年龄、体重指数(BMI)、血压(BP)划分亚组,比较不同年龄组性别比,计算各亚组在总人群中的占比和TN检出率,选取基数大、检出率具有差异的典型亚组。然后将同龄、同性别、BMI、BP均正常的TN者作为对照组,横向与同龄、同性别、BMI、BP均正常的非TN者比较；纵向与同龄、同性别、甲状腺结节发生率存在明显差异的亚组比较。最后参考网络生物学解释TN患病的关键因素。结果52 182名体检者,TN阴性24 040例,TN阳性28 142例。不同年龄组男女比例有差异。54个亚组中49~64岁的人群样本含量和TN患病率均较高。男性正常BMI正常BP组与肥胖高血压组比较,后者TN患病率显著升高,女性亦然(P<0.05)。其中男性,与对照组相比,正常BMI正常BP的非TN体检者TG、GLu、糖化血红蛋白(HbA1c)、总蛋白(TP)、白蛋白(ALB)和甲胎蛋白(AFP)数值偏低。肥胖高血压组的TN患者的ALB、AFP、HDL-C、载脂蛋白A1(Apo-A1)、总胆红素(TBil)和间接胆红素(IBil)降低；TG、GLu、HbA1c、小密低密度脂蛋白胆固醇(sdLDL-C)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、谷氨酰转肽酶(r-GGT)、血清总胆汁酸(TBA)、尿酸(UA)、球蛋白(GLB)、β2微球蛋白(β2-MG)、癌胚抗原(CEA)、碱性磷酸酶(ALP)、C反应蛋白(CRP)升高。其中女性,与对照组相比,正常BMI正常BP甲状腺非TN体检者TBA、LDL-C、直接胆红素、TP、ALB和TC数值偏低。肥胖高血压组TN者的TC、HDL-C、Apo-A1、TBil、IBil降低；TBA、TP、TG、GLu、HbA1c、sdLDL-C、ALT、r-GGT、UA、GLB、β2-MG、CEA、ALP、CRP、总三碘甲状腺原氨酸、总甲状腺素、游离三碘甲状腺原氨酸、乳酸脱氢酶升高(P<0.05)。网络生物学表明以HIF-1α为关键调控因子的Warburg效应是构建组织结构异常和病理性代谢功能障碍的重要桥梁。结论 甲状腺结构的异常,致使机体做出应对,未出现代谢性炎性时,机体尚可启用白蛋白代偿。一旦出现肥胖和高血压,机体将采用更为激进的自适应方式,增加氧输送,抑制氧消耗,厌氧代谢抑制了三羧酸循环,糖脂代谢的恶化非但没有有效遏制,反而机体将承担细胞在增殖凋亡方面进一步恶化的负面后果。 |
| 英文摘要: |
| Objective To compare different subgroups and explain the effect of Glucose-Lipid metabolism on Thyroid Nodules (TN).Methods The people were selected with physical examination at Peking University Hospital from January 2018 to October 2023.The examiners should have TC,TG,HDL-C,LDL-C,GLu and B-ultrasound examination.First,the glucose and lipid metabolism indexes of those diagnosed with TN and non-TN examiners were compared.Then,combining sex,age,body mass index (BMI) and blood pressure (BP),the sex ratios for different age groups were compared.The proportion of each subgroup in the total population was calculated,and the TN detection rate of each subgroup was calculated.The typical subgroups with large base and different detection rate were compared,and the patients with same gender,normal age,BMI and BP,compared with non-TN with normal age,same gender,BMI and BP,compared with the incidence of TN,and further explore the physical and chemical factors.Finally refer to network biology to explain the key factors of TN disease.Results There were 52 182 examiners,28 142 non-TNpatients,24 040 TN examiners.the sex ratio of the different age groups varied differently.Both sample content and TN prevalence were higher aged 49-64 years.The prevalence of TN was significantly higher in the male normal BMI normal BP group than that of the obese hypertension group,as was true in women (P<0.05).Among men,non-TN examiners with normal BMI and normal BP had low values of TG,GLu,glycated hemoglobin (HbA1c),total protein (TP),albumin (ALB),and alpha-fetoprotein (AFP) compared with the control group.Decreased ALB,AFP,HDL-C,apolipoprotein-A1(Apo-A1),total bilirubin (TBil) and indirect bilirubin (IBil) in TN patients in the obese hypertensive group;TG,GLu,HbA1c,small dense low density lipoprotein cholesterol (sdLDL-C),aspartate aminotransferase (AST),alanine aminotransferase (ALT),glutamyl transpeptidase (r-GGT),serum total bile acid (TBA),uric acid (UA),globulin (GLB),β2 microglobulin (β2-MG),carcinoembryonic antigen (CEA),alkaline phosphatase (ALP),C reactive protein (CRP) were increased.Among women,patients with normal BMI and normal BP non-TN examiners had lower values of TBA,LDL-C,DBil,TP,ALB and TC compared with the control group.In the obese hypertensive group,TC,HDL-C,Apo-A1,TBil,IBil decreased;TBA,TBP,TP,TG,GLu,HbA1c,sdLDL-C,ALT,r-GGT,UA,GLB,β2-MG,CEA,ALP,CRP,total triiodothyronine,total thyroxine,free triiodothyronine,lactate dehydrogenase increased (P <0.05).Network biology showed thatWarburg effect with HIF-1α as a key regulator was an important bridge to construct tissue structural abnormalities and pathological metabolic dysfunction.Conclusions The abnormal structure of the thyroid gland causes the body to respond.When there is no metabolic inflammation,the body can still use albumin compensation.Once obesity and hypertension occur,the body will adopt a more aggressive adaptive way to increase oxygen delivery and inhibit oxygen consumption,and anaerobic metabolism suppresses the tricarboxylic acid cycle.The deterioration of glucose and lipid metabolism is not effectively contained,but the body will bear the negative consequences of further deterioration in cell proliferation and apoptosis. |
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