^(131)I核素治疗Graves病对甲亢性糖尿病的影响及其相互关系的探讨  

To Investigate the Relationships and Affects between Hyperthyroidism with Diabetes Mellitus and ^(131)I Radionuclide Therapy

作　　者：孔令华[1] 王雪芹[1] 吴俊渊[1] 顾凯凯[1] 高彬[1] 

机构地区：[1]南通大学第二附属医院核医学科,江苏南通226001

出　　处：《中外医疗》2011年第23期1-3,共3页China & Foreign Medical Treatment

摘　　要：目的为了探讨131I核素治疗Graves病对甲亢合并糖尿病患者的影响并了解其相互关系。方法根据1999年WHO糖尿病诊断标准和Graves病诊断标准,排除其它相关影响因素,对69例甲亢合并糖尿病患者随机分组35例经ATD控制病情,在甲硫咪唑停药1周,丙基硫氧嘧啶停药至少2周后,行131I核素治疗;34例采用ATD治疗。分别于治疗后1、3、6个月进行TSH、FT3、FT4以及空腹血糖、餐后2h血糖的测定。Graves病疗效判定标准依次为治愈、好转、无效、甲减。糖尿病疗效评价标准分别为显效、好转、无效。结果 6个月131I核素治疗后复查35例患者Graves病治愈26例(74.29%),其中糖尿病有效25例(71.43%)、无效1例(2.86%);Graves病好转5例(14.29%),其中糖尿病有效5例(14.29%);Graves病无效0例;甲减4例(11.43%),其中糖尿病有效4例(11.43%)。Graves病治愈率为85.71%,糖尿病有效率为97.14%。6个月ATD治疗后复查34例患者Graves病治愈1例(2.94%),其中糖尿病有效1例(2.94%);Graves病好转26例(76.47%),其中糖尿病有效12例(35.29%),糖尿病无效14例(41.18%);Graves病无效或过敏7例(20.59%),其中糖尿病无效7例(20.59%);甲减0例。Graves病治愈率为2.94%,糖尿病有效率为38.24%。131I核素治疗组与ATD治疗组之间的Graves病治愈率和糖尿病有效率,差异均有统计学意义(P<0.01)。结论 Graves病合并糖尿病的可能因素有:(1)甲状腺激素可促进小肠葡萄糖和乳糖的吸收,加速肝内糖原分解,还可增强交感神经活性,抑制胰岛素分泌;(2)甲亢时体内的高血糖可能引起胰岛B细胞受损,使部分患者发生胰腺萎缩,如同甲亢性心脏病,如果不及时控制甲亢,有可能变成器质性损害,1例无效考虑是此因素;(3)甲亢时易并发低钾血症,从而造成胰岛素分泌不足;(4)两者可能有共同的遗传学、免疫学基础。因此对于甲亢合并糖尿病者,只要无禁忌证,131I治疗最为适宜,不仅尽快控制甲亢,同时有利于糖�Objective To investigate the radionuclide 131I treatment of hyperthyroidism with Graves Disease on the impact of diabetes and to understand their relationship.Methods According to the 1999 WHO diagnostic criteria for diabetes and Graves disease diagnostic criteria,the exclusion of other relevant factors,69 patients with hyperthyroidism were randomly assigned 35 patients with diabetes control the disease by ATD,stopping in Methimazole week propylthiouracil at least 2 weeks after drug withdrawal,OK 131I radionuclide therapy;34 patients treated with ATD.1、3、6,respectively,after treatment,months TSH,FT3,FT4,and fasting blood glucose,postprandial 2h blood glucose determination.Graves disease determine the efficacy of the standard were cured,improved,ineffective,hypothyroidism.Evaluation criteria were diabetes mellitus markedly,improved invalid.Results 6 months after 131I radionuclide therapy in patients with Graves disease 35 cases reviewed 26 cases（74.29%）,and among effective in 25 cases（71.43%）,1 patient（2.86%）;Graves disease,5 cases improved（14.29%）,in which 5 cases of diabetes and effective（14.29%）;Graves disease 0 ineffective;hypothyroidism in 4 cases（11.43%）,and diabetes in 4 cases（11.43%）.Graves disease the cure rate was 85.71% and 97.14% effective rate of diabetes.ATD 6 months after treatment,review of 34 patients cured one case of Graves disease（2.94%）,in which the effective one case of diabetes（2.94%）;Graves disease improvement in 26 patients（76.47%）,and among 12 patients（35.29%）diabetes,14 cases were ineffective（41.18%）;Graves invalid or allergic disease in 7 cases（20.59%）,including diabetes,7 cases（20.59%）;hypothyroidism 0.The cure rate was 2.94% Graves disease,diabetes effective rate of 38.24%.131I radionuclide therapy group treated with ATD cure rate between Graves disease and diabetes is efficient,the differences were statistically significant（P0.01）.Conclusion Graves disease associated with diabetes may be factors：（1）thyroid hormones

关 键 词：格雷夫斯病 糖尿病 放射疗法 碘放射性同位素 

分 类 号：R581[医药卫生—内分泌]