【摘要】 目的 探究血清糖化血红蛋白（HbA1c）、淋巴细胞活化基因-3（LAG-3）与2型糖尿病（T2DM）患者合并甲状腺结节的相关性。方法 纳入河北医科大学第三医院2021年7月至2022年7月收治的T2DM合并甲状腺结节患者120例，设为研究组；同期选取单纯T2DM患者（无甲状腺结节）100例作为对照组。根据甲状腺结节的病理学检查结果将研究组分为良性结节组（85例）和恶性结节组（35例）。采用酶联免疫吸附试验检测所有研究对象血清LAG-3水平；全自动糖化血红蛋白分析仪检测所有研究对象HbA1c水平。采用Spearman法分析T2DM合并甲状腺结节患者血清中HbA1c、LAG-3与甲状腺影像报告与数据系统（TI-RADS）评分的相关性。采用多因素Logistic回归分析T2DM合并甲状腺结节的影响因素。采用受试者工作特征（ROC）曲线分析HbA1c、LAG-3水平对T2DM合并甲状腺结节的诊断价值。结果 与对照组比较，研究组HbA1c水平升高（P<0.05）,LAG-3水平降低（P<0.05）。与良性结节组比较，恶性结节组血清中LAG-3水平降低（P<0.05）,HbA1c水平升高（P<0.05）。Spearman法分析结果显示，T2DM合并甲状腺结节患者HbA1c水平与TI-RADS评分呈正相关（r=0.378,P<0.001）;血清LAG-3水平与TI-RADS评分呈负相关（r=-0.472,P<0.001）。多因素Logistic回归分析结果显示，HbA1c是T2DM患者发生甲状腺结节的危险因素（P<0.05）,LAG-3是T2DM患者发生甲状腺结节的保护因素（P<0.05）。HbA1c、LAG-3联合诊断T2DM合并甲状腺结节优于二者单独诊断(Z_{二者联合-HbA1c}=2.542,P=0.011;Z_{二者联合-LAG-3}=3.098,P=0.002)。结论 T2DM合并甲状腺结节患者血清LAG-3水平明显降低，HbA1c水平明显升高，二者与甲状腺结节的恶性程度有关。更多还原

【Abstract】 Objective To explore the correlation between serum glycosylated hemoglobin（HbA1c）,lymphocyte activation gene-3（LAG-3） and thyroid nodules in patients with type 2 diabetes mellitus（T2DM）.Methods A total of 120 T2DM patients with thyroid nodules admitted to the Third Hospital of Hebei Medical University from July 2021 to July 2022 were included as the study group, and 100 simple T2DM patients（without thyroid nodules） were included as the control group during the same period.According to the pathological examination results of thyroid nodules, the study group was grouped into a benign nodule group（85 cases） and a malignant nodule group（35 cases）.Enzyme linked immunosorbent assay was applied to detect the serum LAG-3 level of all study subjects.Fully automated glycated hemoglobin analyzer was applied to detect HbA1c level in all study subjects.Spearman method was applied to analyze the correlation between serum HbA1c, LAG-3,and thyroid imaging report and data system（TI-RADS） scores in patients with T2DM and thyroid nodules.Multivariate Logistic regression was applied to analyze the influencing factors of T2DM with thyroid nodules.Receiver operating characteristic（ROC） curve was applied to analyze the diagnostic value of HbA1c and LAG-3 levels in T2DM with thyroid nodules.Results Compared with the control group, the level of HbA1c in the study group was obviously higher（P<0.05）,while the level of LAG-3 was obviously lower（P<0.05）.Compared with the benign nodule group, the serum LAG-3 level in the malignant nodule group was obviously lower（P<0.05）,while the level of LAG-3 was obviously lower（P<0.05）.Spearman analysis showed a positive correlation between HbA1c level and TI-RADS score in T2DM patients with thyroid nodules（r=0.378,P<0.001）,while the serum LAG-3 level was negatively correlated with TI-RADS score（r=-0.472,P<0.001）.The results of multivariate Logistic regression analysis showed that HbA1c was a risk factor for the occurrence of thyroid nodules in T2DM patients（P<0.05）,and LAG-3 was a protective factor for the occurrence of thyroid nodules in T2DM patients（P<0.05）.The combination of HbA1c and LAG-3 in the diagnosis of T2DM with thyroid nodules was superior to their individual diagnosis(Z_{combination-HbA1c}=2.542,P=0.011;Z_{combination-LAG-3}=3.098,P=0.002).Conclusion Patients with T2DM combined with thyroid nodules have obviously lower serum LAG-3 level and higher HbA1c level, and the two are related to the malignancy of thyroid nodules.更多还原