甲状腺功能亢进症对糖代谢影响及临床意义

目的 了解甲状腺功能亢进症（简称“甲亢”）对糖代谢的影响及临床意义.方法 以西溪街道社区卫生服务中心65例糖尿病为研究对象,按对象属性分为：A组22例甲亢伴糖尿病;B组23例糖尿病;C组20例单纯甲亢.AB 2组均采用胰岛素多次注射强化降糖方案,A组口服他巴唑或丙基硫氧嘧啶,C组采用常规甲亢治疗,疗程均为3周.观察各组治疗前后空腹血糖（fasting plasma glucose,FPG）及餐后2h血糖（2 h BG）、心率、血清三碘甲状腺原氨酸（TT3）、血清总甲状腺素（TT4）等各项指标变化.结果 经胰岛素强化治疗后,AB 2组治疗前后的FPG、2hBG都在可控制范围内;A组的TT3、TT4较治疗前下降速度明显加快（P＜0.05）;A组血糖达标时需要的胰岛素量要高于B组（P＜0.05）,但3周后的胰岛素用量相近;A组的血糖达标所需要的时间高于B组（P＜0.05）.此外,A组治疗前后的心率变化比另2组都大并在试验后降至正常水平（P＜0.05）.结论 甲状腺激素会影响糖代谢过程.糖尿病并发甲亢是因伴有糖代谢异常或胰岛素抵抗.强化降糖治疗是改善胰岛β细胞功能,起到快速控制血糖的疗效,但与单纯糖尿病相比,也应把握时间和剂量,尽量在初期加大剂量.

Effects of hyperthyroidism on glucose metabolism and its clinical significance

Objective To understand effects of hyperthyroidism on glucose metabolism and its clinical significance.Methods 65 patients admitted in Xixi Street Community Health Center were divided into 3 groups according to their accompanying disease：group A,22 cases of hyperthyroidism accompanying with diabetes mellitus,group B,23 cases of diabetes,and group C,20 cases of hyperthyroidism.Group A and B were treated with intensive insulin therapy.Group B patients took oral methimazole or propylthiouracil.Group C patients were treated with conventional treatment of hyperthyroidism.All patients were treated for three weeks.Fasting plasma glucose （FPG） and postprandial 2h plasma glucose （2hBG）,heart rate,serum triiodothyronine three （TT3）,serum total thyroxine （TT4）and other indicators were recorded before and after treatment.Results After intensive insulin therapy,FPG and 2h BG of patients in group A and B were controlled in ideal range.After treatment,TT3 and TT4 decreased significantly faster than before treatment（P ＜ 0.05）.Patients in group A needed more insulin than in group B to bring the blood glucose to the normal level（P ＜0.05）,but after three weeks,patients in group A and group B needed similar dose of insulin.Patients in group A needed more time than patients in group B to bring down the blood glucose level.（P ＜ 0.05）.In addition,change of heart rate in group A before and after treatment were greater than the other two groups,and patients＇ heart rate in group A returned to normal after three weeks of treatment.（P ＜ 0.05）.Conclusions Thyroid hormones affects glucose metabolism.Diabetes complicated with hyperthyroidism mainly caused by patient＇s abnormal glucose metabolism and insulin resistance.Intensive insulin therapy for these patients can improve β cell function,lower blood glucose rapidly.Compared with diabetes patient without complication of hyperthyroidism,early intensive insulin therapy should be considered.