重型地中海贫血患儿糖代谢指标检测及并发糖尿病的发病机制研究  

Detection of glycometabolism indexes and study on the pathogenesis of diabetes mellitus in children with severe thalassemia

作　　者：曾聪灵 陈国华[1] 魏苗苗[1] 陈书远[1] 张旸[1] 易容松 ZENG Congling;CHEN Guohua;WEI Miaomiao;CHEN Shuyuan;ZHANG Yang;YI Rongsong(Department of Pediatrics,Huizhou First People's Hospital,Huizhou,Guangdong 516000,China;Department of Pediatrics,Liuzhou Maternal and Child Healtheare Hospital,Liuzhou,Guangxi 545001)

机构地区：[1]惠州市第一人民医院儿科,广东惠州516000 [2]柳州市妇幼保健院儿科,广西柳州545001

出　　处：《徐州医科大学学报》2019年第1期38-41,共4页Journal of Xuzhou Medical University

基　　金：惠州市科技计划项目(2018Y057);广西壮族自治区卫生厅自筹经费科研课题(Z2010456)

摘　　要：目的探讨重型β-地中海贫血患儿糖代谢指标及并发糖尿病的可能发病机制。方法选取120例重型β-地中海贫血儿童为研究对象,依据是否发生糖代谢异常分为A组(重型β-地中海贫血合并血糖异常,n=16)与B组(重型β-地中海贫血未合并血糖异常,n=104),另选取同期120例健康体检儿童为对照组,检测全部研究对象空腹血糖(FBG)、糖化血红蛋白(HbAlc)、空腹胰岛素(FINS)、血清铁蛋白(SF),计算胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-B)。分析铁过载与血糖相关指标的关系,采用多重线性回归分析评估血糖相关指标对SF的影响。结果本研究中120例重型β-地中海贫血儿童中10.00%空腹血糖受损,3.33%的儿童确诊为糖尿病。A组FBG、FINS、HOMA-IR显著高于B组及对照组,HOMA-B低于B组及对照组,差异有统计学意义(P<0.05)。A组SF水平显著高于B组,差异有统计学意义(P<0.05)。SF与FBG、HO-MA-IR呈正相关,与HOMA—B呈负相关(P<0.05)。SF与HbAlc、FINS无相关性(P>0.05)。SF与FBG、HO-MA-β、HOMA-IR独立相关(P<0.05)。结论重型β-地中海贫血儿童存在一定血糖代谢异常风险,需引起临床重视;重型β-地中海贫血儿童糖尿病发病机制可能与铁过载导致的胰岛素抵抗及胰岛素分泌功能下降有关。Objective To investigate the detection of glycometabolism indexes and the possible pathogenesis of diabetes mellitus in children with severe β-thalassemia.Methods A total of 120 children with severe β-thalassemia were selected and were assigned to group A (severe β-thalassemia with abnormal blood glucose,n =16)and group B (severe β-thalassemia without abnormal blood glucose,n =104)according to whether disordered glycometabolism was found.A total of 120 healthy children were selected in the same period as the control group.Fasting blood glucose (FBG),glycated hemoglobin (HbAlc),fasting insulin (FINS)and serum ferritin (SF)were detected in all the subjects.The insulin resistance index (HOMA-IR)and insulin secretion index (HOMA-13)were calculated.The rela-tionship between iron overload and blood glucose related indexes Were analyzed.Multiple linear regression analysis was performed to evaluate the effect of blood glucose related indexes on SF.Results Among 120 children with severe β- thalassemia,10% had impaired fasting blood glucose and 3.33% were diagnosed with diabetes.The levels of FBG, FINS and HOMA -IR were significantly higher in group A than those in group B and control group,while the level of HOMA -β was lower in group A than that in B group and control group (P <0.05 ).The level of SF in group A was significantly higher than that in group B (P <0.05).SF was positively correlated with FBG and HOMA -IR and negatively correlated with HOMA -β (P <0.05).SF has no correlation with HbAlc and FINS (P >0.05 ).The results of multiple linear stepwise regression analysis showed that SF was independently correlated to FBG,HOMA -IR and HOMA -β (P <0.05 ).Conclusions Children with severe β -thalassemia have a certain risk of abnormal glucose metabolism,which should be paid more attention.The pathogenesis of diabetes in children with severe β-thalassemia may be related to the increase of insulin resistance and the decrease of insulin secretion caused by iron overload.

关 键 词：重型Β-地中海贫血 糖代谢 糖尿病 发病机制 

分 类 号：R556.6[医药卫生—血液循环系统疾病]