Hypothyroidism Influence On Serum Ghrelin Level Of Type2Diabetic Patients With Coronary Heart Disease

Objective: Ghrelin is a small molecular peptides which was originallyfound in rat stomach bottom endocrine cell, have promote growth hormonerelease, enhance gastriv bowel peristalsis, adjustment energy metabolism,affect pancreatic endocrine function, regulate glucolipid metabolism,improve cell endothelial dysfunction, reduce vascular resistance, protectcardiac function, enhance immunity and many other kinds of biological effect.Existing research shows that Ghrelin level is reduced in type2diabetesmellitus (T2DM) patients, and when T2DM combined with CHD it’s declinedfurther. On the side, according to epidemiological survey, Diabetes and thyroiddisease extremely easy to happen together, especially diabetes mellitus withhypothyroidism, and abnormal of blood lipid metabolic, which is caused byhypothyroidism, will further increase the risk of cardiovascular disease. ourstudy attempts to analysis of plasma ghrelin level variation characteristics andits related factors of T2DM merger coronary heart disease and thyroid diseasefrom the clinical point view, to analysis whether hypothyroidism has effect onserum ghrelin level and on the ouccer of type2diabetes complicated withcoronary heart disease.Methods: In this experiment, The subjects are randomly divided into fourgroups, each group with22cases. The subjects of group A, B were come theMedical Examination Center of the Second Hospital of Hebei MedicalUniversity. Group A is healthy controls, including male9cases, female13cases. And group B is simple type2diabetes mellitus group (had beendiagnosed formerly or diagnosed type2diabetic patients newly), include male12cases, female10cases. All the cases were have normal thyroid function,and were exclude acute and chronic infection, liver and kidney disfunction,malignant tumoras and the immune system disease, and were denied coronary heart disease and hypertension. The subjects of group C and D were selectedfrom the Second Affiliated Hospital of Hebei Medical University patients withtype2diabetes, and T2DM candidates are in line with the WHO1999type2diabetes diagnosis standard. Group C is consist with type2diabetescomplicated with coronary heart disease but thyroid function were normal,inculde male11cases, female11cases. The group D is consist with type2diabetes complicated with coronary heart disease and hypothyroidism group,include male9cases, female13cases. Thyroid test are in line with thesubclinical hypothyroidism or clinical hypothyroidism diagnosis standard.Above volunteers were exclude diabetic ketoacidosis, diabetic peripheralneuropathy, diabetic microvascular complication, acute and chronic infection,malignant tumoras, liver and kidney disfunction and the immune systemdisease, etc.All subjects were collected in order to get general information inculdheight, weight, blood pressure (BP), body mass index (BMI). Collectedvenous blood save to-40℃refrigerator for measuring serum ghrelin level,Fasting insulin (FINS) and C-reactive protein (CRP) level, Meanwhile, fastingplasma glucose (FPG), triglyceride (TG), blood cholesterol (TC), high densitylipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL),glycated hemoglobin (HbA1c), Thyroid functionand as so on other indicatorswere determined.All data using SPSS13.0statistical soft ware to analysis. P <0.05wasconsidered statistically significant. Normal data results use the mean+SD,analysis of variance was used in multiple comparison between groups, andthe data among groups are compared with S-N-K method; non normal dataresults use median or the four percentile interval, comparison groups selectionrank and inspection. Spearman correlation analysis was used in two indexcorrelation, multiple regression analysis using logistic regression analysis andmultiple stepwise regression analysis.Results:1The age between the four groups show that the group C.Dwere higher than group A.B (P<0.05). But the age differences between the C.D groups and A.B groups has no statistically significant (P>0.05). Therewere no significant differences between four groups between the sex ratio andbody mass index (P>0.05).2Compartion of Ghrelin between the four groups show that group B,C,Dis lower than group A (P<0.05), and group C,D are lower than that of groupB (P<0.05),and group D is lower than group C, but the difference between thelast two groups has no statistically significant (P>0.05).3Compartion of lipid between the four groups show that total cholesterolcontent and low density lipoprotein between the four groups had no significantdifference; TG in group D was higher than in group A, the difference wasstatistically significant (P<0.05); but the differences between the threegroups has no statistically significant (P>0.05). High density lipoprotein incase groups is lower than that in the healthy control group (P<0.05), andhave statistical significant difference; the differences among case groups hasno statistically significant (P>0.05).4The comparison of glucose indexes between the four groups: Fastingglucose and glycosylated hemoglobin of control groups was higher than that ingroup A (P<0.05), but the differences among the three groups was notstatistically significant (P>0.05). Insulin resistance index, group B washigher than the other three groups (P<0.05), while among the other threegroups, the differences has no statistically significant (P>0.05).5Comparison of thyroid function among the four groups, TSH of groupD was higher than that of the other three groups (P<0.05), and there was nosignificant difference between the other three groups about TSH (P>0.05).FT3of group D was lower than that in group A,B and C, the difference wasstatistically significant (P<0.05), but the differences among the three groupshad no statistical significance (P>0.05). The content of FT4between the fourgroups had no significant difference(P>0.05).6Plasma ghrelin, C-reactive protein level and the results of the thyroid,blood biochemical indexes and general index analysis results of Spearmancorrelation: Plasma ghrelin has has apositive correlation with HDL; has negative correlation with age, blood pressure, BMI, FBG, HbA1c, TG, TSH,FINS, HOMA-IR, Atherosclerosis, fatty liver and course of diabetes; and withFT4, FT3, CHOL, LDL, CPR was no significant correlation. HS-CRP levelhas positive correlation with FBG, course of diabetes; and negative correlationwith plasma HDL; and no significant correlation with TSH, FT3,FT4, HbA1c,FINS, HOMA-IR, LDL, TG, CHOL, BMI, blood pressure, atherosclerosis,fatty liver and age.7There is whether with peripheral hypertension, arteriosclerosis, fattyliver of type2diabetes as a sub group, comparison of the content of severalgroups of plasma ghrelin, show that hypertension group was lower than that innormal blood pressure group (P<0.05); hardening of the arteriosclerosis werelower than that of normal group (P<0.05); the ghrelin of fatty liver group waslower than normal group (P<0.05).8The results of Logistic regression analysis of whether have coronaryheart disease with T2DM patients as dependent variable: ghrelin, HDL areprotective factors of type2diabetes complicated with coronary heart disease;and age, course of diabetes, atherosclerosis are independent risk factors; butthyroid function has not entered the regression equation.9The results of Multiple stepwise regressionnalysis of whether havecoronary heart disease with T2DM patients as dependent variable: HbA1c,FINS, HDL, age, arteriosclerosis have line arregression coefficients relationswith plasma ghrelin level of patients with type2diabetes; but thyroid functionhas not entered the regression equation.Conclusions:1Our study found there is a decrease of ghrelin level in patients withtype2diabetes, and T2DM patients with coronary heart disease was lower,has statistically significant; If hypothyroidism is occurred, the level of serumghrelin has a tendency to reduce, but has no statistically significant differencewith the level of serum ghrelin in normal thyroid funtion.2Low level of ghrelin is closely related to the occurrence anddevelopment of type2diabetes complicated with coronary heart disease, ghrelin is a protective factor of type2diabetes complicated with coronaryheart disease.3When2diabetes complicated with hypertension, arteriosclerosis andfatty liver, the level of serum ghrelin was obviously reduced. Ghrelin may be aprotective factor, influence the occurrence of hypertension, arteriosclerosisand fatty liver.4Serum ghrelin level and HDL was positively correlated; and age, bloodpressure, BMI, FBG, HbA1c, TG, TSH, FINS, HOMA-IR, arteriosclerosis,fatty liver, course of diabetes was negatively correlated.5Although our study found that serum ghrelin level of2diabetes is ona certain extent, affected by TSH, but not found the direct influence of thyroidfuntion change on the occurr of coronary heart disease.