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目的观察抗甲状腺药物治疗Graves病(GD)前后胰岛素抵抗(Insulin resistance,IR)的变化及IR程度与GD患者对抗甲状腺药物疗效的影响。方法选择门诊及住院初发GD患者48例为观察对象,据IR抵抗程度由高到低分为治疗组A、治疗组B各24名;选择同期健康查体者24名为对照组C。治疗组应用ATD丙基硫氧嘧啶每日300-450mg,分三次口服,共8周。治疗组A与治疗组B用药剂量无差异,分别于治疗前后化验游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、空腹血糖(FPG)、空腹胰岛素(INS);计算稳态模型评估的胰岛素抵抗指数(HOMA-IR)=(INS×FPG/22.5)。结果治疗组A治疗后FT3、FT4较前明显下降(P<0.01),但仍然高于正常参考值;治疗组B治疗后FT3、FT4均下降(P<0.01)至正常参考值范围。治疗后FT4在A、B两组差异比较有统计学意义。治疗后A、B两组IR均明显下降,与治疗前比较差异有统计学意义(P<0.01);治疗后治疗组AIR明显高于治疗组B和对照组C(P<0.01),治疗组B和对照组C比较差异无统计学意义(P>0.05)。结论GD患者IR随着血中甲状腺激素下降而减轻,血中甲状腺激素降至正常参考值后,IR恢复于正常对照组水平。GD患者IR越严重,抗甲状腺药物治疗后控制病情、血中甲状腺激素水平降至正常参考值的时间将明显延长。
Objective To observe the changes of insulin resistance (IR) before and after antithyroid drug treatment of Graves disease (GD) and the effect of IR on the efficacy of anti-thyroid drugs in GD patients. Methods Outpatients and hospitalized GD patients 48 cases were observed, according to the degree of IR resistance from high to low treatment group A, treatment group B each 24; select the same period of physical examination 24 were control group C. The treatment group with ATD propylthiouracil daily 300-450mg, three times orally for a total of 8 weeks. There was no difference in the dosage of treatment A and treatment B between the two groups. FT3, TSH, FPG, fasting insulin (INS). The HOMA-IR was calculated as (INS × FPG / 22.5). Results After treatment, the FT3 and FT4 in treatment group A were significantly decreased (P <0.01), but still higher than the normal reference values. FT3 and FT4 in treatment group B decreased (P <0.01) to the normal reference range. After treatment FT4 in A, B difference between the two groups was statistically significant. After treatment, the IR of A and B groups decreased significantly compared with that before treatment (P <0.01); after treatment, the AIR in treatment group was significantly higher than that in treatment group B and control group C (P <0.01) There was no significant difference between B and control group C (P> 0.05). Conclusion The IR of GD patients is reduced with the decrease of thyroid hormones in the blood and the levels of thyroid hormone in the blood return to the normal reference values. GD patients with the more severe IR, anti-thyroid drug treatment to control the disease, blood thyroid hormone levels dropped to the normal reference time will be significantly longer.