抗甲状腺药物治疗Graves病前后胰岛素抵抗变化

Alteration of insulin resistance in antithyroid drug treating Graves disease

目的观察抗甲状腺药物治疗Graves病(GD)前后胰岛素抵抗(Insulin resistance,IR)的变化及IR程度与GD患者对抗甲状腺药物疗效的影响。方法选择门诊及住院初发GD患者48例为观察对象,据IR抵抗程度由高到低分为治疗组A、治疗组B各24名;选择同期健康查体者24名为对照组C。治疗组应用ATD丙基硫氧嘧啶每日300-450mg,分三次口服,共8周。治疗组A与治疗组B用药剂量无差异,分别于治疗前后化验游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、空腹血糖(FPG)、空腹胰岛素(INS);计算稳态模型评估的胰岛素抵抗指数(HOMA-IR)=(INS×FPG/22.5)。结果治疗组A治疗后FT3、FT4较前明显下降(P<0.01),但仍然高于正常参考值;治疗组B治疗后FT3、FT4均下降(P<0.01)至正常参考值范围。治疗后FT4在A、B两组差异比较有统计学意义。治疗后A、B两组IR均明显下降,与治疗前比较差异有统计学意义(P<0.01);治疗后治疗组AIR明显高于治疗组B和对照组C(P<0.01),治疗组B和对照组C比较差异无统计学意义(P>0.05)。结论GD患者IR随着血中甲状腺激素下降而减轻,血中甲状腺激素降至正常参考值后,IR恢复于正常对照组水平。GD患者IR越严重,抗甲状腺药物治疗后控制病情、血中甲状腺激素水平降至正常参考值的时间将明显延长。

Objective To observe the alteration of insulin resistance （IR） in Graves diseas （GD） treated by antithyroid drug（ ATD）, and the relationship between the effect of ATD and IR. Methods 48 outpatients and inpatients were divided into two groups by IR degree, group A（N =24） and group B（N =24）, 24 healthy subjects were recuited as control group C. Group A and group B had been given propyhhioureil 300 - 450mg/day for 8 weeks. The level of FT3, FT4, TSH, FPG, INS were determined before and after treatment, and HOMA - IR was measured. Results FT3, FT4 of group A was significantly decreased （P 〈 0.01 ）, but still higher than normal range; FT3 and FT4 of group B significantly was decreased（ P 〈 0.01 ） to normal range. There was great difference of FT4 level between group A and B after treatment （ P 〈 0.01 ）. HOMA - IRs of group A and group B were signifi- candy decreased （P 〈0.01 ）. HOMA - IR of group A was higher than those of group B and control group C （P 〈0. 01） after treatment. Conclusion With the decrease of blood thyroxine level, the IR degree of GD decreases. When blood thyroxine level decreases to normal range, the IR resumed to the level of group C. The time of ATD controlling patient＇ s condition and blood thyroxine level decreases to normal range will delay with the gravity of IR degree.