甲状腺功能亢进症患者治疗前后血糖波动及胰岛素分泌特征的临床研究

Blood glucose variability and insulin secretion in patients with hyperthyroidism before and after treatment

目的采用动态监测系统评估甲状腺功能亢进症(以下简称甲亢)患者治疗前后血糖波动并观察胰岛素分泌的改变。方法选取江苏省南通市海门区人民医院确诊的30例甲亢患者,葡萄糖耐量试验、胰岛素释放试验及动态血糖监测,比较治疗前后患者血糖波动及评估胰岛素水平及胰岛素抵抗指数。结果甲亢治疗前,女性患者日间血糖波动幅度、最大血糖波动幅度、日间血糖平均绝对差、血糖标准差水平明显低于男性患者(P<0.05)。甲亢治疗后患者餐后1 h葡萄糖、餐后1 h胰岛素、餐后2 h胰岛素和胰岛素抵抗指数、血糖波动幅度(日间平均血糖度、最大血糖度、日间血糖平均绝对差、餐后血糖曲线下面积)低于治疗前(P<0.05)。结论甲亢患者的血糖波动较大,以餐后血糖升高为主,并发生胰岛素抵抗,且男性甲亢患者血糖波动更为显著。甲亢患者在经治疗后胰岛素抵抗程度、餐后血糖和血糖变异性等随着甲状腺功能的恢复而改善。

Objective To evaluate the fluctuation of blood glucose and insulin secretion in patients with hyperthyroidism before and after treatment.Methods Thirty patients with hyperthyroidism admitted in Nantong Haimen People's Hospital were enrolled in the study.Patients received oral glucose tolerance test insulin release test and dynamic blood glucose monitoring before and after treatment.Blood glucose fluctuation,insulin level and insulin resistance index(HOMA-IR)were compared before and after treatment.Results The levels of diurnal mean amplitude of glucose excursions(MAGE),largest amplitude of glycemic excursion(LAGE),mean absolute difference of glucose(MODD)and standard deviation of blood glucose(SDBG)before and after treatment in female patients were significantly lower than those in male patients(P<0.05).The P1BG,1hINS,2hINS and HOMA-IR,blood glucose of fluctuation range(LAGE,MAGE,MODD and AUC PBG)of patients with hyperthyroidism after treatment were lower than those before treatment(P<0.05).Conclusion Patients with hyperthyroidism have substantial fluctuations in blood glucose with increased postprandial blood glucose and insulin resistance,which are more significant in male patients.The degree of insulin resistance,increased postprandial blood glucose and blood glucose variability in hyperthyroidism patients can be improved with the recovery of thyroid function after effective treatment.