甲状腺功能亢进症患儿糖代谢紊乱的研究--胰岛素拮抗和胰岛素受体变化

目的 :探讨甲亢患儿糖代谢紊乱的特点及发生的可能机制。方法 :检测 2 9例甲亢患儿血糖、胰岛素、C肽、胰高糖素、皮质醇及T3 、T4、TSH、TGA、TMA ,并与 2 0例正常健康儿童进行比较。采用放射受体分析法对 14例甲亢患儿进行了红细胞胰岛素受体的检测 ,以 7名健康儿童作为对照。结果 :甲亢患儿糖代谢紊乱发生率 34.5 % ,病程 >1年者糖代谢紊乱发生率高于 <1年者。甲亢糖耐量低减组餐后 6 0min胰岛素、胰岛素 /血糖、胰岛素 /胰高糖素显著升高 ;红细胞膜高、低亲和力胰岛素受体数目餐前、餐后自身对照均明显下降。结论 :甲亢儿童存在糖代谢紊乱现象 ,表现为葡萄糖耐量低减和胰岛素拮抗 ,其发生与病程有关 ,病程较长 ,发生率较高。靶细胞受体数目减少可能是甲亢糖代谢紊乱及胰岛素抵抗的重要原因。

Evaluation of glucose metabolic disorder in hyperthyroidism children:insulin resistance and abnormal insulin receptors

Objective:To evaluate features and underlying pathogenesis of glucose metabolic disorder in pediatric patients with hyperthyroidism.Methods:The levels of blood glucose,insulin,c-peptide,glucagon,cortisol,T 3,T 4,TSH,TGA,TMA were measured in 29 patients with hyperthyroidism.20 normal age-matched children served as controls.In addition,fasting and post-prandial 60-minute erythrocyte insulin receptor of 14 children with hyperthyroidism and 7 normal age-matched controls were measured using insulin radioreceptor assay.Results:Incidence of glucose metabolic disorder was 34.5%.Incidence of glucose metabolic disorder in patients with more than one year course was higher compared with cases with less than one year course.In hyperthyroidism with glucose metabolic disorder,levels of glucose,insulin,insulin/glucose,insulin/glucagon at post-prandial 60 minute increased significantly.Numbers of fasting insulin receptor of high and low affinity in erythrocyte membrane were lower than post-prandial insulin receptor.Conclusion:Glucose metabolic disorder with impaired glucose tolerance and insulin resistance are present in patients with hyperthyroidism.The longer the course of the disease,the higher the incidence of glucose metabolic disorder.The decrease in the number of insulin receptor in target cells might play an important role in the mechanisms of glucose metabolic disorder and insulin resistance in children with hyperthyroidism.