甲状腺功能异常对糖代谢的影响

发布时间：2018-05-26 09:28

本文选题：甲状腺功能亢进 + 甲状腺功能减退　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:探究甲状腺功能异常对糖代谢的影响以及甲亢和甲减患者胰岛功能的变化,为甲亢以及甲减患者的糖代谢治疗提供临床参考。方法:1收集2014年1月到2016年1月保定市第一中心医院内分泌科甲亢患者98例作为甲亢组、甲减患者95例作为甲减组,健康志愿者93例作为正常对照组。2甲亢组给予甲巯咪唑治疗,甲减组给予优甲乐治疗,治疗时间为6个月。3在进行药物治疗前和药物治疗6个月后,采用化学发光法检测各组患者甲状腺功能(TSH、TT3、TT4、FT3、FT4)。并分别检测三组患者空腹血糖(Fasting Blood Glucose,FBG)、空腹静脉血清胰岛素(Fasting Intravenous Insulin,FINS),行口服葡萄糖耐量试验(Oral Glucose Tolerance Test,OGTT),检测服用75g无水葡萄糖2小时后静脉血糖、静脉血清胰岛素(2h Intravenous Insulin,2hINS)。计算胰岛素抵抗指数(Homeostasis Model Assessment of Insulin Resistance,HOMA-IR),将所测得的数据进行整理分析。4应用SPSS 21.0软件分析,计量数据采用均数±标准差(？)表示,组间比较采用单因素方差分析;胰岛素、HOMA-IR若为正态分布,则组间比较采用单因素方差分析,若为非正态分布,则取其自然对数应用非参数秩和检验进行统计分析。P0.05,差异具有统计学意义。结果:1治疗前后甲状腺功能变化甲亢组:与治疗前比较,TT3、TT4、FT3、FT4在治疗后明显降低,TSH在治疗后明显升高,差异有统计学意义。(各组指标平均值分别为:TT3(7.82±1.37)nmol/L vs(3.76±1.52)nmol/L、TT4(198.38±12.54)nmol/L vs(87.17±9.63)nmol/L、FT3(8.91±0.67)pmol/L vs(6.91±0.79)pmol/L、FT4(38.98±5.69)pmol/Lvs(30.96±2.23)pmol/L,TSH(0.21±0.06)miu/lvs(1.79±0.13)miu/l,p0.05);甲减组:与治疗前比较,tt3、tt4、ft3、ft4在治疗后明显升高,tsh治疗后明显下降,差异有统计学意义。(各组指标平均值分别为:tt3(1.15±0.23)nmol/lvs(2.84±0.61)nmol/l、tt4(38.95±5.47)nmol/lvs(56.32±4.73)nmol/l、ft3(1.08±0.05)pmol/lvs(1.75±0.28)pmol/l、ft4(6.72±1.43)pmol/lvs(10.24±1.96)pmol/l,tsh(7.62±1.05)miu/lvs(3.87±0.16)miu/l,p0.05);2三组人群血糖、胰岛素功能的测定与正常对照组比较,甲亢组空腹血糖、餐后2小时血糖,空腹胰岛素、2小时静脉血胰岛素以及homa-ir均升高,差异有统计学意义。(各组指标平均值分别为:空腹血糖(5.68±0.23)mmol/lvs(4.77±0.26)mmol/l,p0.05;餐后2血糖(7.85±0.31)mmol/lvs(6.14±0.33)mmol/l,p0.05;空腹胰岛素(12.86±3.52)uiu/mlvs(11.38±2.97)uiu/ml,p0.05;2小时静脉血胰岛素(31.82±5.67)uiu/mlvs(20.63±5.15)uiu/ml,p0.01;homa-ir(3.24±0.18)vs(2.41±0.19),p0.05;与正常对照组比较,甲减组空腹血糖、餐后2小时血糖,空腹胰岛素,2小时静脉血胰岛素以及homa-ir均降低,差异有统计学意义。(各组指标平均值分别为:空腹血糖(4.34±0.29)mmol/lvs(4.77±0.26)mmol/l,p0.05;餐后2小时血糖(5.77±0.27)mmol/lvs(6.14±0.33)mmol/l,p0.05空腹胰岛素(10.23±3.29)uiu/mlvs(11.38±2.97)uiu/ml,p0.05;2小时静脉血胰岛素(19.67±5.21)uiu/mlvs(20.63±5.15)uiu/ml,p0.05;homa-ir(1.97±0.21)vs(2.410±0.19),p0.05;3甲亢组治疗前后糖代谢变化甲亢组:与治疗前比较,空腹血糖、餐后2小时血糖,空腹胰岛素、2小时静脉血胰岛素、homa-ir指标治疗后明显降低,差异有统计学意义。(各组指标平均值分别为:空腹血糖(5.68±0.23)mmol/lvs(4.89±0.21)mmol/l,p0.05;餐后2小时血糖(7.85±0.31)mmol/lvs(6.75±0.19)mmol/l,p0.05;空腹胰岛素(12.86±3.52)uiu/mlvs(10.36±2.89)uiu/ml,p=0.016;2小时静脉血胰岛素(31.82±5.67)uiu/mlvs(23.51±3.65)uiu/ml,p0.01;homa-ir(3.24±0.18)vs(2.25±0.24),p0.05;4甲减组治疗前后糖代谢变化甲减组:与治疗前比较,餐后2h血糖、空腹胰岛素,2小时静脉血胰岛素、HOMA-IR治疗后明显降低,差异有统计学意义。空腹血糖治疗前后无统计学意义。各组指标平均值分别为:空腹血糖(4.34±0.29)mmol/Lvs(4.11±0.17)mmol/L,P0.05;餐后2小时血糖(5.77±0.27)mmol/Lvs(6.88±0.23)mmol/L,P0.05;空腹胰岛素(10.23±3.29)uIU/mlvs(11.38±2.37)uIU/ml,P0.05;2小时静脉血胰岛素(19.67±5.21)u IU/ml vs(22.19±3.37)uIU/ml,P0.05;HOMA-IR(1.97±0.21)vs(1.12±0.15),P0.01。结论:1甲状腺激素可以促进糖代谢加速,甲亢患者可导致糖代谢紊乱,使血糖升高。2甲状腺功能减退时可导致糖代谢减慢,血糖降低。3药物治疗能够改善甲亢、甲减患者胰岛功能。
[Abstract]:Objective: To investigate the effect of abnormal thyroid function on glucose metabolism and the changes of pancreatic islet function in hyperthyroidism and hypothyroidism, and to provide clinical reference for hyperthyroidism and hypothyroidism. 1. 98 cases of hyperthyroidism in Baoding First Central Hospital from January 2014 to January 2016 were collected as hyperthyroidism group and 95 cases of hypothyroidism were made. For the hypothyroidism group, 93 healthy volunteers were treated with methimazole in the normal control group of.2 hyperthyroidism group, and the hypothyroidism group was treated with methylene music. The treatment time was 6 months before and 6 months after the drug treatment. The thyroid work ability of each group was detected by chemiluminescence (TSH, TT3, TT4, FT3, FT4). And the three groups were detected respectively. Fasting Blood Glucose (FBG), Fasting Intravenous Insulin, FINS, oral glucose tolerance test (Oral Glucose Tolerance Test), venous blood glucose after 2 hours, and insulin resistance index. (Homeostasis Model Assessment of Insulin Resistance, HOMA-IR), the measured data are arranged and analyzed for the analysis of.4 application SPSS 21 software, the measurement data are expressed in mean number of standard deviation (?), and a single factor analysis of variance is used in the group. If the insulin and HOMA-IR are normal distribution, then the single factor analysis of variance is used in the group, if a single factor analysis of variance is used. If For the non normal distribution, the natural logarithm of the non parametric rank sum test was taken for statistical analysis of.P0.05. The difference was statistically significant. Results: before and after treatment, the thyroid function changes in hyperthyroidism group: compared with before treatment, TT3, TT4, FT3, FT4 were significantly reduced after treatment, and TSH was significantly increased after treatment, the difference was statistically significant. (the differences were statistically significant. (the indexes of each group) were statistically significant. The mean values were TT3 (7.82 + 1.37) nmol/L vs (3.76 + 1.52) nmol/L, TT4 (198.38 + 12.54) nmol/L vs (87.17 + 9.63) nmol/L, FT3 (8.91 + 0.67) pmol/L vs (6.91 + 0.79) pmol/L. The difference was statistically significant after TSH treatment. The average values of each group were TT3 (1.15 + 0.23) nmol/lvs (2.84 + 0.61) nmol/l, TT4 (38.95 + 5.47) nmol/lvs (56.32 + 4.73) nmol/l, FT3 (1.08 + 0.05) pmol/lvs (1.75 + 0.28) pmol/l, FT4 (6.72 + 1.43) pmol/lvs. U/l, P0.05); 2 groups of three groups of blood glucose, insulin function measurement compared with the normal control group, hyperthyroidism group fasting blood glucose, postprandial 2 hours blood glucose, fasting insulin, 2 hours of venous blood insulin and HOMA-IR increased, the difference was statistically significant. (the average value of each group was: fasting blood glucose (5.68 + 0.23) mmol/lvs (4.77 + 0.26) mmol/l, P0.05 The postprandial 2 blood glucose (7.85 + 0.31) mmol/lvs (6.14 + 0.33) mmol/l, P0.05, fasting insulin (12.86 + 3.52) uiu/mlvs (11.38 + 2.97) uiu/ml, P0.05, 2 hours venous blood insulin (31.82 + 5.67) uiu/mlvs (20.63 + 5.15) uiu/ml, P0.01; HOMA-IR (HOMA-IR) vs, P0.05. Fasting insulin, 2 hours of venous blood insulin and HOMA-IR decreased, and the difference was statistically significant. (the average values of each group were: fasting blood glucose (4.34 + 0.29) mmol/lvs (4.77 + 0.26) mmol/l, P0.05, 2 hours postprandial blood glucose (5.77 + 0.27) mmol/lvs (6.14 + 0.33) mmol/l, P0.05 fasting insulin (10.23 + 3.29) uiu/mlvs (11.38 +) uiu/ml, P 0.05, 2 hours of venous blood insulin (19.67 + 5.21) uiu/mlvs (20.63 + 5.15) uiu/ml, P0.05; HOMA-IR (1.97 + 0.21) vs (2.410 + 0.19), P0.05; hyperthyroidism group before and after treatment of hyperthyroidism group: compared with before treatment, fasting blood glucose, postprandial serum glucose, empty abdominal insulin, 2 hour intravenous insulin, HOMA-IR index decreased significantly after treatment, and the difference was poor after treatment. The average values were: fasting blood glucose (5.68 + 0.23) mmol/lvs (4.89 + 0.21) mmol/l, P0.05, 2 hours postprandial blood glucose (7.85 + 0.31) mmol/lvs (6.75 + 0.19) mmol/l, P0.05, fasting insulin (12.86 + 3.52) uiu/mlvs (10.36 + 2.89) uiu/ml, p=0.016; Iu/ml, P0.01, HOMA-IR (3.24 + 0.18) vs (2.25 + 0.24), P0.05, and 4 hypothyroidism group before and after treatment of hypothyroidism group: compared with before treatment, postprandial 2H blood sugar, fasting insulin, 2 hours of venous blood insulin, HOMA-IR treatment significantly decreased, the difference was statistically significant. There was no statistical significance before and after the treatment of fasting blood glucose. The average value of each group of indexes was respectively Fasting blood glucose (4.34 + 0.29) mmol/Lvs (4.11 + 0.17) mmol/L, P0.05, 2 hours postprandial blood glucose (5.77 + 0.27) mmol/Lvs (6.88 + 0.23) mmol/L, P0.05; fasting insulin (10.23 + 3.29) uIU/mlvs (11.38 + 2.37) uIU/ml, P0.05; 1. conclusion: 1 thyroid hormone can promote the acceleration of glucose metabolism, hyperthyroidism can lead to disorder of glucose metabolism, increase blood sugar and lead to impaired glucose metabolism when.2 hypothyroidism is hypothyroidism, and hypoglycemic.3 therapy can improve hyperthyroidism and pancreatic islet function in hypothyroidism.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587

【参考文献】