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目的探讨胰岛素强化治疗对糖尿病(diabetes mellitus,DM)患者甲状腺激素及抑郁状态的影响。方法选取本院2013年1月—2015年1月期间因DM合并抑郁症就诊的患者87例,随机分为观察组45例和对照组42例,给予观察组胰岛素强化治疗,给予对照组磺脲类降糖药物治疗,治疗周期为90 d。治疗前后对两组患者进行甲状腺激素包括游离四碘甲状腺原氨酸(free thyroxine,FT4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、促甲状腺激素(thyroidstimulating hormone,TSH)测定,并在治疗前后采用抑郁自评量表(self-rating depression scale,SDS)和汉密尔顿抑郁量表(Hamilton depression scale,HAMD)进行抑郁状态评估,比较两组患者甲状腺激素测定和抑郁状态评估结果。计量资料比较采用t检验,计数资料比较采用χ2检验,P<0.05为差异有统计学意义。结果与对照组[(60.59±14.88)、(45.21±10.44)pmol/L,(0.18±0.01)μIU/ml]比较,治疗后观察组FT4、FT3水平[(51.12±12.30)、(37.63±9.91)pmol/L]显著降低,TSH水平[(0.26±0.17)μIU/ml]显著升高,差异均有统计学意义(均P<0.05)。治疗后观察组患者的SDS、HAMD评分[(22.43±5.36)、(7.73±4.38)分]显著低于对照组[(30.21±5.04)、(12.48±4.01)分],差异均有统计学意义(均P<0.05)。治疗后观察组患者的FPG、2 h PBG水平[(4.18±0.69)、(12.16±1.07)mmol/L]显著低于对照组[(5.57±2.11)、(13.94±1.39)mmol/L],差异均有统计学意义(均P<0.05)。结论胰岛素强化治疗能显著降低DM患者的甲状腺激素水平,缓解患者抑郁状态,从而可改善患者心理状态、提高患者生活质量。
Objective To investigate the effects of intensive insulin therapy on thyroid hormones and depression in patients with diabetes mellitus (DM). Methods A total of 87 patients with DM with depression in our hospital from January 2013 to January 2015 were randomly divided into observation group (n = 45) and control group (n = 42). The observation group received intensive insulin therapy and the control group received sulfonylureas Class hypoglycemic drug treatment, the treatment cycle is 90 d. Thyroid hormones including free thyroxine (FT4), free triiodothyronine (FT3) and thyroid stimulating hormone (TSH) were measured in both groups before and after treatment. Before and after treatment, self-rating depression scale (SDS) and Hamilton depression scale (HAMD) were used to evaluate depression status. Thyroid hormone test and depression status evaluation were compared between the two groups. Measurement data were compared using t test, count data were compared using χ2 test, P <0.05 for the difference was statistically significant. Results Compared with the control group [(60.59 ± 14.88), (45.21 ± 10.44) pmol / L, (0.18 ± 0.01) μIU / ml], the levels of FT4 and FT3 in the observation group after treatment [(51.12 ± 12.30) and (37.63 ± 9.91 ) pmol / L], and the levels of TSH [(0.26 ± 0.17) μIU / ml] were significantly increased (all P <0.05). After treatment, the scores of SDS and HAMD in observation group [(22.43 ± 5.36) and (7.73 ± 4.38)] were significantly lower than those in control group [(30.21 ± 5.04) and (12.48 ± 4.01)], respectively (All P <0.05). The levels of FPG and 2 h PBG in the observation group were significantly lower than those in the control group [(4.18 ± 0.69), (12.16 ± 1.07) mmol / L] [(5.57 ± 2.11), (13.94 ± 1.39) mmol / L] The differences were statistically significant (all P <0.05). Conclusion Intensive insulin therapy can significantly reduce the level of thyroid hormone in DM patients and relieve the depression of patients, which can improve the psychological status of patients and improve the quality of life of patients.