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目的:探讨甲状腺功能异常时患者的糖代谢状态。方法:对100例甲状腺功能亢进(甲亢组)、50例甲状腺功能减退(甲减组)和50例健康者(对照组)进行葡萄糖耐量试验(OGTT)及胰岛素激发试验(OGIRT),并计算胰岛素抵抗指数(HOMA-IR)、胰岛细胞分泌功能(HOMA-β)、胰岛素敏感指数(HOMA-IS)。抗甲状腺治疗6个月后,甲亢合并糖代谢异常患者及甲减患者复查OGTT试验及OGIRT试验。结果:甲亢组空腹血糖(FPG)、OGTT2h血糖(2h PG)、餐后胰岛素水平(2h INS)及HOMA-IR均较对照组明显增高(P<0.01),甲亢组HOMA-IS较对照组明显降低(P<0.01)。甲亢组OGTT试验提示80例存在糖代谢异常;甲减组FPG、2h PG均较对照组偏低,FTNS、2h INS、HOMA-IS与对照组相比无明显差异(P>0.05),甲减组HOMA-IR较对照组明显升高(P<0.05),HOMA-β较对照组降低(P<0.05)。抗甲状腺治疗后,80例甲亢组并糖代谢异常患者、50例甲减复查OGTT试验及OGIRT试验,甲亢组FPG、2h PG、2h INS、HOMA-IR明显降低(P<0.01),而HOMA-β和HOMA-IS则较治疗前增高(P<0.01)。甲减组HOMA-IR和HOMA-β明显改善,FPG、2h PG、2h INS与对照组相比无明显差异(P>0.05)。结论:甲亢时常合并胰岛素抵抗及糖代谢异常,甲减对糖代谢的影响临床意义不大。
Objective: To investigate the status of glucose metabolism in patients with abnormal thyroid function. Methods: OGTT and OGIRT were performed in 100 cases of hyperthyroidism (hyperthyroidism group), 50 cases of hypothyroidism (hypothyroidism group) and 50 healthy controls (control group), and insulin Resistance index (HOMA-IR), islet cell secretory function (HOMA-β) and insulin sensitivity index (HOMA-IS). Anti-thyroid treatment 6 months later, patients with hyperthyroidism and abnormal glucose metabolism and hypothyroidism OGTT test and OGIRT test review. Results: The levels of fasting blood glucose (FPG), OGTT2h blood glucose (2h PG), postprandial insulin levels (2h INS) and HOMA-IR in hyperthyroidism group were significantly higher than those in control group (P <0.01) Decreased (P <0.01). Hyperthyroidism group OGTT test showed 80 cases of abnormal glucose metabolism; hypothyroidism FPG, 2h PG were lower than the control group, FTNS, 2h INS, HOMA-IS compared with the control group, no significant difference (P> 0.05), hypothyroidism HOMA-IR was significantly higher (P <0.05) and HOMA-β was lower in control group (P <0.05). In the hyperthyroidism group, FPG, 2h PG, 2h INS and HOMA-IR were significantly decreased (P <0.01) in 50 hyperthyroidism patients with abnormal glucose metabolism, 50 hypothyroidism OGTT test and OGIRT test, while HOMA- β and HOMA-IS were higher than before treatment (P <0.01). HOMA-IR and HOMA-β in hypothyroidism group were significantly improved, FPG, 2h PG, 2h INS had no significant difference compared with the control group (P> 0.05). Conclusion: Hyperthyroidism is often associated with insulin resistance and abnormal glucose metabolism, hypothyroidism on the impact of glucose metabolism is of little clinical significance.