大剂量糖皮质激素治疗甲状腺相关性眼病对糖代谢的影响研究

摘要

目的 观察甲状腺相关性眼病(TAO)患者在予以静脉注射甲泼尼龙(IVMP)治疗后血糖的变化及糖调节受损的发病率,并探讨引起血糖升高的可能机制.方法 纳入2014年5月至2016年12月第二军医大学长征医院收治的90例TAO患者,根据使用糖皮质激素(glucocorticoids,GCs)的累积剂量,研究不同GCs累积剂量下空腹血糖(FPG)、糖负荷后血糖的变化.结果 (1) 90例TAO患者经IVMP治疗后,空腹血糖受损发病率在1.11％(1例)、且与GCs累积剂量不相关(r=0.080,P=0.452);其中22例行糖耐量试验的TAO患者中,27.27％(6例)的患者使用IVMP治疗后出现糖调节受损,糖调节受损的发病率与GCs累积剂量无关(r=-0.296,P=0.181);(2) IVMP治疗后糖负荷异常TAO患者(HBG组)与糖负荷正常TAO患者(NBG组)比较,Composite胰岛素敏感指数、口服胰岛素敏感指数降低(P＜0.05);胰岛素抵抗指数、定量胰岛素敏感检测指数、HOMR-β、胰岛素生成指数、口服处置指数、C肽曲线下面积与血糖曲线下面积比值无明显变化(P＞0.05);DI0、DI120、DI180等指标均降低(P＜0.05).结论 (1)IVMP治疗可引起部分患者血糖升高,但糖调节受损发病率与GCs累积剂量不相关;(2)血糖升高的原因可能主要为胰岛B细胞储备功能不足.%Objective To observe the incidence of impaired glucose regulation after intravenous methylprednisolone (IVMP) treatment in patients with thyroid-associated ophthalmopathy(TAO) and to explore the possible mechanisms of hypoglycemia.Methods Totally 90 patients with TAO were enrolled in this study.The changes of blood glucose were observed under the different cumulative dose of GCs.Results (1) The incidence of FPG abnormality was 1.11％ after IVMP treatment in TAO patients,and the blood glucose level did not increase with the cumulative dose of GCs(r=-0.080,P=0.452).In the 22 patients under OGTT test,27.27％ of TAO patients had abnormal glucose tolerance after treatment with IVMP,and the blood glucose level did not increase with the cumulative dose of GCs(r=--0.296,P=0.181);(2)There were obvious decreases in CISI and OGSI of the HBG group (compared with NBG group,P＜0.05).Compared with the NBG group,the early phase secretion (DI0) and late phase (DI120,DI180) in HBG were declined sharply (P＜0.05).Conclution IVMP treatment in TAO patients can cause elevated blood glucose,but has nothing to do with the cumulative dose of G Cs.lhe mechanism of elevated blood glucose may mainly be pancreatic β-cell reserve dysfunction.