甲状腺腺瘤患者手术应激与高血压胰岛素抵抗和脂联素的关联性  

Relationship of thyroid adenoma surgery with insulin resistance in primary hypertension and adiponectin

作　　者：潘兴寿[1] 李天资[1] 梁烨[1] 卢冠铭[2] 陆克兴[1] 王若琦[1] 马燕飞[2] 刘燕[1] 赖腾芳[1] 

机构地区：[1]右江民族医学院临床学院心内科,广西百色533000 [2]右江民族医学院临床学院腺体外科,广西百色533000

出　　处：《中国急救医学》2012年第1期4-6,共3页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金项目（No.81060028）;广西卫生厅科学基金项目（No.Z2010091）

摘　　要：目的探讨甲状腺腺瘤（TA）患者外科手术应激与原发性高血压（PH）胰岛素抵抗（IR）和脂联素（APN）的关联性。方法手术前和手术后第4天观察12例合并原发性高血压的甲状腺腺瘤（PH＋TA）患者空腹血糖（FBG）、空腹胰岛素（FINS）和APN水平，计算稳态胰岛素评价指数（HOMA—IR），并与12例单纯甲状腺腺瘤患者比较。结果手术前PH＋TA组FBG、FINS和HOMA—IR水平显著高于TA组（P〈0．01），APN水平显著低于TA组（P〈0．01）；手术后两组FBG、FINS和HOMA—IR水平均有升高（P〈0．01），PH＋TA组显著高于TA组（P〈0．01），两组APN水平比较差异无统计学意义（P〉0．05）。血压对APN、FBG、FINS和HOMA—IR水平变化有作用（P〈0．01）；手术应激对FBG、FINS和HOMA—IR水平变化也有作用（P〈0．01）；血压和手术应激对FBG、FINS和HOMA—IR水平变化有交互作用（P〈0．01），对APN水平变化均无作用（P〉0．05）。结论手术应激可加重合并原发性高血压的甲状腺腺瘤患者的胰岛素抵抗，临床上控制原发性高血压合并甲状腺腺瘤患者的高血压，纠正胰岛素抵抗，对促进术后康复或许有积极的意义。Objective To study relationship of thyroid adenoma （TA） with insulin resistance in primary hypertension （PH） and adiponectin （APN） after surgical stress. Methods Fasting blood glucose （FBG） , fasting insulin and APN were observed in 12 patients with PH and TA before surgery and after surgery, and HOMA - IR was counted. 12 cases of simply TA were selected as controls. Results Compared with simple TA group, level of FBG, fasting insulin and HOMA - IR were all higher （P 〈0. 01 ）, but APN was lower in group of PH and TA before surgery（P 〈0. 01 ）. They all increased in the two groups after surgery （ P 〈0. 01 ）, especially in group of PH and TA （ P 〈 0. 01 ）. There was no statistical significance in APN of the two groups （P 〉 0. 05 ）. Blood pressure had an effect on the changes of APN, FBG, fasting insulin and HOMA -IR （P 〈 0. 01 ）. Surgical stress had an effect on the changes of FBG, fasting insulin and HOMA -IR （P 〈 0.01 ）. Blood pressure and surgical stress had the interaction on FBG, fasting insulin and HOMA - IR （ P 〈 0. 01 ）, excluding APN （ P 〉 0. 05 ）. Conclusion Operation stress will aggravate insulin resistance of patients with primary PH and TA. It is positive significance in postoperative rehabilitation by the control of hypertension and the correction of insulin resistance in the patients with PH and TA. Correction of insulin resistance to facilitate postoperative rehabilitation may have positive significance. It has energetic meaning to promote postoperative rehabilitation in patients with PH and TA by control hypertension and retrieve IR.

关 键 词：高血压 胰岛素抵抗 脂联素 应激反应 甲状腺腺瘤 

分 类 号：R544.1[医药卫生—心血管疾病]