甲状腺功能亢进症患儿合并糖代谢紊乱10例临床分析

Evaluation of glucose metabolism disorder in hyperthyroidism children

目的 探讨儿童甲亢患者糖代谢紊乱的特点。方法 用SUPERGLUCOCARDTM血糖仪和放射免疫方法检测 2 9例甲亢患儿餐前、餐后 60min、12 0min血糖和餐前、餐后 60min胰岛素、C肽、胰高糖素、皮质醇及T3、T4、TSH、TGA、TMA(其中 10例糖耐量减低为甲亢 1组 ,另 19例糖耐量正常为甲亢 2组 ) ,并与 2 0例健康儿童进行比较。结果 (1) 3 4 .5 %甲亢患儿出现糖代谢紊乱 ,病程大于 1年和小于 1年糖代谢紊乱发生率为 5 0 % ,9% (P <0 .0 5 )。 (2 )甲亢 1组餐后 60min胰岛素、胰岛素 /血糖、胰岛素 /胰高糖素显著升高 (P <0 .0 5 )。结论 甲亢儿童存在糖代谢紊乱现象 ,表现为葡萄糖耐量减低和胰岛素拮抗 ,其发生与病程有关 ,病程较长 ,发生率较高。糖代谢紊乱可能与自身免疫。

Objective To evaluate features of glucose metabolism disorder in pediatric patients with hyperthyroidism. Methods Fasting, post prandial 60 minute and post prandial 120 minute blood glucose were measured using SUPER GLUCOCARD TM glucose meter.The levels of insulin,c peptide,glucagon,cortisol in fasting and post prandial 60 minute and T 3,T 4,TSH, anti thyroglobulin antibody(TGA), anti microsomal antibody(TMA) in fasting were measured using radio immunity assay(RIA) in 29 patients with hyperthyroidism .The patients were divied into two groups :group one included 10 cases impaired glucose tolerance and group two consisted of 19 cases with normal glucose tolerance. 20 nomal age matched children served as controls. Results (1)Abnormal glucose metabolism were found in 34.5% patients with hyperthyroidism.Incidence of glycometabolic disorder was 50% in patients with more than one year course compared with 9% in cases with less than one year disease course( P <0.05).(2)In hyperthyroidism with glycometabolic disorder(group1).Levels of glucose, insulin, insulin/glucose, insulin/glucagon in post prandial 60 minute were significantly increasing. Conclusions Glycometabolic disorder with impaired glucose tolerance and insulin resistance are present in patients with hyperthyroidism. The longer was course of the disease,the higher was incidence of glycometabolism. Glycometabolic disorder is possible correlated with autoimmunity, the impaired β islet cells and insulin resistance.