甲泼尼龙对甲状腺眼病患者糖代谢的影响  

Effect of short-term methylprednisolone on blood glucose metabolism in patients with thyroid eye disease

作　　者：陈岚[1] 方瑾[2] 顾明君[2] 

机构地区：[1]上海市北医院内科,200443 [2]第二军医大学附属长征医院内分泌科

出　　处：《上海医学》2009年第5期428-430,共3页Shanghai Medical Journal

摘　　要：目的观察甲泼尼龙静脉冲击治疗甲状腺眼病对患者糖代谢的影响。方法30例血糖正常(正常血糖组)和12例合并2型糖尿病(糖尿病组)的活动性中重度甲状腺眼病患者接受甲泼尼龙500mg+0.9%氯化钠溶液250mL静脉滴注冲击治疗,3d为1个疗程,间隔4d,共4个疗程,甲泼尼龙的总剂量为6000mg。比较冲击治疗前、冲击治疗4个疗程和停止冲击治疗1周时的血糖水平或胰岛素注射剂量的变化。结果正常血糖组中,治疗4个疗程的空腹血糖和餐后2h血糖均显著高于治疗前(P值均<0.01),但均在正常范围内,停止治疗1周时均恢复至基线水平(P值均>0.05)。糖尿病组中,行冲击治疗时每例患者增加胰岛素注射剂量6～14U,血糖水平维持稳定;停止冲击治疗后1周时,每例患者的胰岛素注射剂量减少2～4U,基本恢复至原剂量。结论甲泼尼龙静脉冲击治疗甲状腺眼病时可暂时升高血糖水平,特别是对合并糖尿病者应严密监测血糖,及时调整胰岛素注射剂量。Objective To investigate the effect of short-term methylprednisolone on blood glucose in patients with thyroid eye disease （TED）. Methods Totally 42 patients with TED, including 30 non-diabetics and 12 diabetics, received intravenous infusion of methyiprednisolone （500 mg/d） for 3 consecutive days; the treatment was repeated 4 times at an interval of 4 days, with a total dose of 6 000 mg. Close clinical care including close glycemic monitoring was practiced. The changes of fasting- and postprandial-blood glucose levels in non-diabetics and the increase in injection dosage of insulin in diabetics before, at the end of methylprednisolone therapy, and one week after stopping the therapy were compared. Results Thirty non-diabetics showed increased fasting- and postprandial-blood glucose levels （all P〈0.01 ） within the normal range at the end of 4 courses. However, the increased fasting- and postprandial-blood glucose levels returned to the baseline values one week after therapy （both P〉0.05）. Injection dosage of exogenous insulin in 12 diabetics increased by 8 to 15 units per day to maintain stable blood glucose levels during the therapy and returned to the baseline dose one week after the therapy. Conclusion Short-term methylprednisolone treatment can cause transient increase of blood glucose level in non-diabetics and increase of insulin injection dose in diabetics. Glycemic monitoring is necessary for TED patients, especially for those with diabetes mellitus and being treated with methylprednisolone. （Shanghai Med J, 2009, 32： 428-430）

关 键 词：甲泼尼龙 甲状腺眼病 血糖 

分 类 号：R771.3[医药卫生—眼科]