本文選題：甲狀腺功能亢進(jìn) + 甲狀腺功能減退　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探究甲狀腺功能異常對(duì)糖代謝的影響以及甲亢和甲減患者胰島功能的變化,為甲亢以及甲減患者的糖代謝治療提供臨床參考。方法:1收集2014年1月到2016年1月保定市第一中心醫(yī)院內(nèi)分泌科甲亢患者98例作為甲亢組、甲減患者95例作為甲減組,健康志愿者93例作為正常對(duì)照組。2甲亢組給予甲巰咪唑治療,甲減組給予優(yōu)甲樂(lè)治療,治療時(shí)間為6個(gè)月。3在進(jìn)行藥物治療前和藥物治療6個(gè)月后,采用化學(xué)發(fā)光法檢測(cè)各組患者甲狀腺功能(TSH、TT3、TT4、FT3、FT4)。并分別檢測(cè)三組患者空腹血糖(Fasting Blood Glucose,FBG)、空腹靜脈血清胰島素(Fasting Intravenous Insulin,FINS),行口服葡萄糖耐量試驗(yàn)(Oral Glucose Tolerance Test,OGTT),檢測(cè)服用75g無(wú)水葡萄糖2小時(shí)后靜脈血糖、靜脈血清胰島素(2h Intravenous Insulin,2hINS)。計(jì)算胰島素抵抗指數(shù)(Homeostasis Model Assessment of Insulin Resistance,HOMA-IR),將所測(cè)得的數(shù)據(jù)進(jìn)行整理分析。4應(yīng)用SPSS 21.0軟件分析,計(jì)量數(shù)據(jù)采用均數(shù)±標(biāo)準(zhǔn)差(？)表示,組間比較采用單因素方差分析;胰島素、HOMA-IR若為正態(tài)分布,則組間比較采用單因素方差分析,若為非正態(tài)分布,則取其自然對(duì)數(shù)應(yīng)用非參數(shù)秩和檢驗(yàn)進(jìn)行統(tǒng)計(jì)分析。P0.05,差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1治療前后甲狀腺功能變化甲亢組:與治療前比較,TT3、TT4、FT3、FT4在治療后明顯降低,TSH在治療后明顯升高,差異有統(tǒng)計(jì)學(xué)意義。(各組指標(biāo)平均值分別為: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);甲減組:與治療前比較,tt3、tt4、ft3、ft4在治療后明顯升高,tsh治療后明顯下降,差異有統(tǒng)計(jì)學(xué)意義。(各組指標(biāo)平均值分別為: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);2三組人群血糖、胰島素功能的測(cè)定與正常對(duì)照組比較,甲亢組空腹血糖、餐后2小時(shí)血糖,空腹胰島素、2小時(shí)靜脈血胰島素以及homa-ir均升高,差異有統(tǒng)計(jì)學(xué)意義。(各組指標(biāo)平均值分別為: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;空腹胰島素(12.86±3.52)uiu/mlvs(11.38±2.97)uiu/ml,p0.05;2小時(shí)靜脈血胰島素(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;與正常對(duì)照組比較,甲減組空腹血糖、餐后2小時(shí)血糖,空腹胰島素,2小時(shí)靜脈血胰島素以及homa-ir均降低,差異有統(tǒng)計(jì)學(xué)意義。(各組指標(biāo)平均值分別為:空腹血糖(4.34±0.29)mmol/lvs(4.77±0.26)mmol/l,p0.05;餐后2小時(shí)血糖(5.77±0.27)mmol/lvs(6.14±0.33)mmol/l,p0.05空腹胰島素(10.23±3.29)uiu/mlvs(11.38±2.97)uiu/ml,p0.05;2小時(shí)靜脈血胰島素(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甲亢組治療前后糖代謝變化甲亢組:與治療前比較,空腹血糖、餐后2小時(shí)血糖,空腹胰島素、2小時(shí)靜脈血胰島素、homa-ir指標(biāo)治療后明顯降低,差異有統(tǒng)計(jì)學(xué)意義。(各組指標(biāo)平均值分別為:空腹血糖(5.68±0.23)mmol/lvs(4.89±0.21)mmol/l,p0.05;餐后2小時(shí)血糖(7.85±0.31)mmol/lvs(6.75±0.19)mmol/l,p0.05;空腹胰島素(12.86±3.52)uiu/mlvs(10.36±2.89)uiu/ml,p=0.016;2小時(shí)靜脈血胰島素(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甲減組治療前后糖代謝變化甲減組:與治療前比較,餐后2h血糖、空腹胰島素,2小時(shí)靜脈血胰島素、HOMA-IR治療后明顯降低,差異有統(tǒng)計(jì)學(xué)意義。空腹血糖治療前后無(wú)統(tǒng)計(jì)學(xué)意義。各組指標(biāo)平均值分別為:空腹血糖(4.34±0.29)mmol/Lvs(4.11±0.17)mmol/L,P0.05;餐后2小時(shí)血糖(5.77±0.27)mmol/Lvs(6.88±0.23)mmol/L,P0.05;空腹胰島素(10.23±3.29)uIU/mlvs(11.38±2.37)uIU/ml,P0.05;2小時(shí)靜脈血胰島素(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。結(jié)論:1甲狀腺激素可以促進(jìn)糖代謝加速,甲亢患者可導(dǎo)致糖代謝紊亂,使血糖升高。2甲狀腺功能減退時(shí)可導(dǎo)致糖代謝減慢,血糖降低。3藥物治療能夠改善甲亢、甲減患者胰島功能。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R587

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