甲状腺机能亢进症患者糖耐量的改变及其机理分析

目的 :探讨甲状腺机能亢进症 (甲亢 )患者糖耐量的改变及其发病机理。方法 :对 110例甲亢患者进行葡萄糖耐量试验 (OGTT) ,根据OGTT结果将病人分为 2组 :糖耐量减低者为A组 ,糖耐量达诊断糖尿病标准者为B组 ,并设立正常对照组 (C组 )。采用胰岛素释放试验进行空腹及早餐后 2h血糖、胰岛素测定 ,计算胰岛素敏感性指标(ISI)、胰岛素抵抗指数 (HOMA -IR)及胰岛细胞分泌功能指标 (HOMA -IS)。结果 :糖耐量减低者 37例 (A组 ,占 33. 6 % ) ,糖耐量达诊断糖尿病标准者 14例 (B组 ,占 12 7% ) ,A、B两组餐后 2h血糖较对照组明显增高 (P<0 0 5 ) ;ISI:A、B两组与对照组相比明显低下 (P <0 0 5 ) ,HOMA -IR :A、B两组与对照组相比明显升高 (P <0 0 5 ) ,HOMA -IS :A组与对照组相比差异无统计学意义 (P >0 0 5 ) ,B组与对照组相比明显低下 (P <0 0 5 )。结论 :甲亢时可影响糖代谢 ,出现高血糖及高胰岛素血症 ,其机理主要与甲状腺激素分泌过多导致胰岛B细胞分泌功能降低及外围组织胰岛素抵抗有关。

Glucose Tolerance Change in Patients with Hyperthyroidism and Mechanism of the Disease

Objective: To investigate the sugar tolerance change and mechanism of hyperthyroidism patients. Methods: 110 hyperthyroidism patients performed oral glucose tolerance test (OGTT) first,then according to OGTT result the patients were divided into 3 groups: group A-OGTT lower,group B - diagnosed diabetic mellitus,and group C-normal control.The fasting blood sugar,2 hours blood sugar after meal,and blood insulin were measured by way of insulin releasing test,and then the insulin sensitive index(ISI),insulin resistant index (HOMA-IR)and index of pancreatic islets secretion function (HOMA-IS)were calculated. Results: There were 37cases (33.6%,group A)with OGTT lower,14 cases (12.7%,group B)with diagnosed diabetics. The 2 hours blood sugar levels after meal in group A and B were obviously higher than that in control group ( P < 0.05). The ISI levels in group A and B were much lower than that in control group ( P < 0.05).The HOMA-IR levels in group A and B were obviously higher than that in control group ( P <0.05).There was no statistically significant difference in HOMA-IS between group A and C ( P >0.05 ),but the HOMA-IS level in group B was much lower than that in group C ( P <0.05).Conclusion:Hyperthyroidism can affect the metabolism of blood sugarand cause hyperglycaemia and hyperinsulinism .We suggest that hyperthyroidism can cause pancreatic islets secretion function decline and peripheral insulin resistance.