2型糖尿病患者TyG指数与甲状腺结节的关联性

doi:10.3969/j.issn.1004-583X.2025.04.006

摘要/Abstract

摘要：

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者甘油三酯-葡萄糖(triglyceride-glucose,TyG)指数与甲状腺结节(thyroid nodules, TN)的关联性。方法选取2022年1月-2023年11月于湖北医药学院附属襄阳市第一人民医院内分泌科住院治疗的T2DM患者365例,其中合并TN(研究组)223例,未合并TN(对照组)142例。获取临床资料, 计算TyG指数, 采用多因素logistic回归分析影响T2DM患者合并TN的独立危险因素;绘制限制性立方样条(restricted cubic spline, RCS)图直观反映TyG指数与T2DM患者TN的关系。结果研究组女性占比、年龄、空腹血糖、总胆固醇、甘油三脂、胰岛素抵抗指数和TyG指数均高于对照组(P<0.05)。多因素logistic回归分析提示,TyG指数升高是T2DM患者发生TN的独立危险因素(P<0.05)。RCS图分析结果显示,T2DM患者TyG指数与TN风险呈现线性剂量反应关系(Poverll<0.001, Pnon-linear=0.65)。结论 TyG指数是T2DM患者发生TN的独立危险因素,随着TyG指数的升高,T2DM患者中TN的发生率显著升高。

关键词: 糖尿病,2型, TyG指数, 甲状腺结节

Abstract:

Objective To investigate the correlation between triglyceride-glucose (TyG) and thyroid nodules (TNs) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 365 T2DM patients hospitalized in the Department of Endocrinology, Xiangyang First People 's Hospital Affiliated to Hubei University of Medicine from January 2022 to November 2023 were selected, including 223 patients with TNs (study group) and 142 patients without TNs (control group). The clinical data were obtained, and the TyG was calculated. Multivariate logistic regression analysis was used to analyze the independent risk factors for TNs in T2DM patients. The restricted cubic spline (RCS) map was drawn to intuitively reflect the relationship between TyG and TNs in T2DM patients. Results The proportion of women, age, fasting blood glucose, total cholestero, triglyceride, insulin resistance index and TyG in the study group were significantly higher than those of the control group (P<0.05). Multivariate logistic regression analysis showed that elevated TyG was an independent risk factor for TNs in T2DM patients (P<0.05). RCS analysis showed that there was a linear dose-response relationship between TyG and TN risk in T2DM patients (Poverll<0.001, Pnon-linear=0.65). Conclusion TyG is an independent risk factor for TNs in T2DM patients. As the TyG increases, the incidence of TNs in T2DM patients significantly increases.

Key words: diabetes mellitus, type 2, TyG index, thyroid nodule

中图分类号:

R587.1

琚盼雨, 杨富琦, 周兴建. 2型糖尿病患者TyG指数与甲状腺结节的关联性[J]. 临床荟萃, 2025, 40(4): 329-333.

Ju Panyu, Yang Fuqi, Zhou Xingjian. Study on the association between triglyceride-glucose and thyroid nodules in patients with type 2 diabetes mellitus[J]. Clinical Focus, 2025, 40(4): 329-333.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.04.006

https://lchc.magtechjournal.com/CN/Y2025/V40/I4/329

图/表 5

表1 两组基本资料及生化指标比较

Tab.1 Basic data and biochemical indexes between the two groups

项目	研究组(n=223)	对照组(n=142)	χ²/ $t$ / $Z$ 值	P值
男[例(%)]	140(62.8)	111(78.2)	9.566	0.002
年龄(岁)	55.99±11.03	52.21±9.86	-3.321	0.001
吸烟[例(%)]	86(38.6)	64(45.1)	1.517	0.218
饮酒[例(%)]	77(34.5)	63(44.4)	3.551	0.060
BMI(kg/m² )	24.47(22.64, 26.91)	24.46(22.47, 27.04)	-0.278	0.781
病程(年)	3.00(1.00, 9.00)	3.00(1.00, 10.00)	-0.548	0.583
高血压[例(%)]	82(36.8)	48(33.8)	0.333	0.564
HbA₁c(%)	9.30(7.40, 11.40)	9.05(7.10, 11.93)	-1.170	0.242
FPG(mmol/L)	7.5(6.44, 8.95)	6.82(5.77, 8.19)	-4.031	0.000
FINS(μU/ml)	6.90(4.80, 11.50)	6.70(4.4011.65)	-1.055	0.292
2hPG(mmol/L)	16.46(13.96, 19.31)	16.06(13.46, 18.29)	-1.328	0.184
TC(mmol/L)	4.94(4.35, 5.69)	4.68(3.90, 5.45)	-2.559	0.011
TG(mmol/L)	1.59(1.10, 2.52)	1.32(0.99, 1.32)	-2.639	0.008
HDL-C(mmol/L)	1.08(0.93, 1.23)	1.11(0.93, 1.29)	-0.801	0.423
LDL-C(mmol/L)	2.73±0.83	2.60±0.91	-1.366	0.173
FT3(pmol/L)	4.12±0.63	4.18±0.62	1.013	0.312
FT4(pmol/L)	13.40(12.44, 14.38)	13.07(11.93, 14.29)	-1.85	0.064
TSH(mIU/L)	1.65(1.18, 2.62)	1.68(1.33, 2.28)	-0.423	0.672
HOMA-IR	2.68(1.70, 4.35)	2.32(1.41, 3.44)	-2.613	0.009
TyG指数	9.31(8.85, 9.88)	8.99(8.68, 9.55)	-3.743	0.000

表1 两组基本资料及生化指标比较

Tab.1 Basic data and biochemical indexes between the two groups

项目	研究组(n=223)	对照组(n=142)	χ²/ $t$ / $Z$ 值	P值
男[例(%)]	140(62.8)	111(78.2)	9.566	0.002
年龄(岁)	55.99±11.03	52.21±9.86	-3.321	0.001
吸烟[例(%)]	86(38.6)	64(45.1)	1.517	0.218
饮酒[例(%)]	77(34.5)	63(44.4)	3.551	0.060
BMI(kg/m² )	24.47(22.64, 26.91)	24.46(22.47, 27.04)	-0.278	0.781
病程(年)	3.00(1.00, 9.00)	3.00(1.00, 10.00)	-0.548	0.583
高血压[例(%)]	82(36.8)	48(33.8)	0.333	0.564
HbA₁c(%)	9.30(7.40, 11.40)	9.05(7.10, 11.93)	-1.170	0.242
FPG(mmol/L)	7.5(6.44, 8.95)	6.82(5.77, 8.19)	-4.031	0.000
FINS(μU/ml)	6.90(4.80, 11.50)	6.70(4.4011.65)	-1.055	0.292
2hPG(mmol/L)	16.46(13.96, 19.31)	16.06(13.46, 18.29)	-1.328	0.184
TC(mmol/L)	4.94(4.35, 5.69)	4.68(3.90, 5.45)	-2.559	0.011
TG(mmol/L)	1.59(1.10, 2.52)	1.32(0.99, 1.32)	-2.639	0.008
HDL-C(mmol/L)	1.08(0.93, 1.23)	1.11(0.93, 1.29)	-0.801	0.423
LDL-C(mmol/L)	2.73±0.83	2.60±0.91	-1.366	0.173
FT3(pmol/L)	4.12±0.63	4.18±0.62	1.013	0.312
FT4(pmol/L)	13.40(12.44, 14.38)	13.07(11.93, 14.29)	-1.85	0.064
TSH(mIU/L)	1.65(1.18, 2.62)	1.68(1.33, 2.28)	-0.423	0.672
HOMA-IR	2.68(1.70, 4.35)	2.32(1.41, 3.44)	-2.613	0.009
TyG指数	9.31(8.85, 9.88)	8.99(8.68, 9.55)	-3.743	0.000

表2 T2DM患者TN危险因素的logistic回归分析

Tab.2 Logistic regression analysis of risk factors for TNs in T2DM patients

因素	回归系数	标准误	Waldχ²值	P值	OR值	95%CI
性别	0.576	0.261	4.859	0.028	1.179	1.066~2.970
年龄	0.041	0.012	12.109	0.001	1.042	1.018~1.066
FPG	0.044	0.053	0.677	0.410	1.045	0.942~1.159
HOMA-IR	0.044	0.052	0.783	0.390	1.045	0.945~1.157
TyG指数	0.652	0.193	11.377	0.001	1.919	1.314~2.802

表3 T2DM患者TyG 指数水平对TN影响的logistic回归模型

Tab.3 Logistic regression model of the effect of TyG on TNs in T2DM patients

	因素	回归系数	Waldχ²值	P值	OR值	95%CI
模型1	Q1	-	10.431	0.005	-	-
	Q2	0.550	4.460	0.035	1.733	1.040~2.888
	Q3	0.847	9.906	0.002	2.333	1.377~3.955
模型2	Q1	-	11.492	0.003	-	-
	Q2	0.612	4.908	0.027	1.844	1.073~3.167
	Q3	1.002	11.067	0.001	2.724	1.509~4.915

表4 T2DM患者TyG指数水平对TN级别增高影响的logistic回归分析

Tab.4 Logistic regression analysis of the effect of TyG level on TNs grade increase in T2DM patients

因素	回归系数	Waldχ²值	P值	OR值	95%CI
Q1	-0.409	1.698	0.193	0.664	0.359~1.228
Q2	-0.039	4.460	0.885	0.962	0.566~1.634

图1 TyG指数与T2DM患者TN风险的RCS分析

Fig.1 RCS analysis of TyG and TN risk in T2DM patients

参考文献 23

[1]	Uppal N, Collins R, James B. Thyroid nodules: Global, economic, and personal burdens[J]. Front Endocrinol (Lausanne), 2023, 14: 1113977.
[2]	Livhits MJ, Zhu CY, Kuo EJ, et al. Effectiveness of molecular testing techniques for diagnosis of indeterminate thyroid nodules: A randomized clinical trial[J]. JAMA Oncol, 2021, 7(1): 70-77. doi: 10.1001/jamaoncol.2020.5935 pmid: 33300952
[3]	Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022, 183: 109119.
[4]	Zhang HM, Feng QW, Niu YX, et al. Thyroid nodules in type 2 diabetes mellitus[J]. Curr Med Sci, 2019, 39(4): 576-581.
[5]	李磊, 彭红叶, 阎早芳, 等. 近十年我国2型糖尿病人群甲状腺结节患病率Meta分析[J]. 中日友好医院学报, 2021, 35(3): 169-171, 192.
[6]	陈明明, 王镁. 2型糖尿病合并甲状腺结节相关因素及机制的研究进展[J]. 中国临床新医学, 2021, 14(10): 1054-1058.
[7]	Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects[J]. Metab Syndr Relat Disord, 2008, 6(4): 299-304. doi: 10.1089/met.2008.0034 pmid: 19067533
[8]	Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp[J]. J Clin Endocrinol Metab, 2010, 95(7): 3347-3351. doi: 10.1210/jc.2010-0288 pmid: 20484475
[9]	Luo P, Cao Y, Li P, et al. TyG index performs better than HOMA-IR in Chinese type 2 diabetes mellitus with a BMI < 35 kg/m²: A Hyperglycemic Clamp Validated Study[J]. Medicina (Kaunas), 2022, 58(7):876.
[10]	Zhao J, Fan H, Wang T, et al. TyG index is positively associated with risk of CHD and coronary atherosclerosis severity among NAFLD patients[J]. Cardiovasc Diabetol, 2022, 21(1): 123. doi: 10.1186/s12933-022-01548-y pmid: 35778734
[11]	Huo RR, Liao Q, Zhai L, et al. Interacting and joint effects of triglyceride-glucose index (TyG) and body mass index on stroke risk and the mediating role of TyG in middle-aged and older Chinese adults: A nationwide prospective cohort study[J]. Cardiovasc Diabetol, 2024, 23(1): 30.
[12]	Wu S, Xu L, Wu M, et al. Association between triglyceride-glucose index and risk of arterial stiffness: A cohort study[J]. Cardiovasc Diabetol, 2021, 20(1): 146. doi: 10.1186/s12933-021-01342-2 pmid: 34271940
[13]	Zhou J, Yin L, Wei X, et al. 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: The C-TIRADS[J]. Endocrine, 2020, 70(2): 256-279.
[14]	Zou B, Sun L, Wang X, et al. The prevalence of single and multiple thyroid nodules and its association with metabolic diseases in Chinese: A cross-sectional study[J]. Int J Endocrinol, 2020, 2020: 5381012.
[15]	陈芳, 吴凯, 杨燕, 等. 2019 - 2021年武汉市成人甲状腺结节患病状况及相关影响因素研究[J]. 中华地方病学杂志, 2023, 42(7): 569-575.
[16]	Yildirim SI, Cetinkalp S, Kabalak T. Review of factors contributing to nodular goiter and thyroid carcinoma[J]. Med Princ Pract, 2020, 29(1): 1-5. doi: 10.1159/000503575 pmid: 31542786
[17]	Wang K, Yang Y, Wu Y, et al. The association between insulin resistance and vascularization of thyroid nodules[J]. J Clin Endocrinol Metab, 2015, 100(1): 184-192. doi: 10.1210/jc.2014-2723 pmid: 25368977
[18]	Demetriou E, Fokou M, Frangos S, et al. Thyroid nodules and obesity[J]. Life (Basel), 2023, 13(6):1292.
[19]	鞠香丽, 裴冬梅. 甲状腺结节患病率与血糖、血脂代谢异常的相关性研究[J]. 实用临床医药杂志, 2020, 24(10): 53-56.
[20]	Mayers RA, Soria MA, Piscoya RA, et al. Association between metabolic syndrome and euthyroid nodular goiter: A case-control study[J]. Colomb Med (Cali), 2019, 50(4): 239-251.
[21]	Parhofer KG. Interaction between glucose and lipid metabolism: More than diabetic dyslipidemia[J]. Diabetes Metab J, 2015, 39(5): 353-362. doi: 10.4093/dmj.2015.39.5.353 pmid: 26566492
[22]	赵建美, 费玉玲, 邵岩. 糖脂代谢与初发2型糖尿病合并甲状腺结节的相关性[J]. 医疗装备, 2022, 35(11): 101-104.
[23]	Xu N, Liu H, Wang Y, et al. Relationship between insulin resistance and thyroid cancer in Chinese euthyroid subjects without conditions affecting insulin resistance[J]. BMC Endocr Disord, 2022, 22(1): 58. doi: 10.1186/s12902-022-00943-6 pmid: 35255873