Klinefelter综合征患者糖代谢分析  

Glucose metabolism in patients with Klinefelter＇s syndrome

作　　者：彭璐[1] 陈光[1] 窦京涛[1] 李乐乐[1] 韩白玉[1] 臧丽[1] 金楠[1] 谷伟军[1] 杜锦[1] 杨丽娟[1] 巴建明[1] 吕朝晖[1] 陆菊明[1] 母义明[1] 

机构地区：[1]解放军总医院内分泌科,北京100853

出　　处：《中华糖尿病杂志》2017年第3期195-199,共5页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的评价Klinfelter综合征（KS）患者糖代谢特点，同时探讨KS患者易发生糖代谢紊乱的可能病因。方法回顾性分析1990年以来在解放军总医院就诊的28例KS患者（包括9例合并糖尿病患者）的一般情况、病史资料和实验室检查结果[性腺激素水平、血脂水平、口服75 g口服葡萄糖耐量试验（OGTT）血糖和胰岛素水平]等临床资料。同时选择18例单纯糖尿病患者与9例合并糖尿病的KS患者按照年龄、体质指数（BMI）、病史进行配对。统计学方法采用完全独立样本t检验及配对样本t检验。结果（1）KS人群中糖尿病发生率为32.1%（9/28），染色体核型为47，XXY的患者糖尿病发生率为30.7%（8/26），染色体核型为48，XXYY患者糖尿病发生率为50%（1/2）；（2）合并糖尿病的KS患者与单纯KS患者相比，年龄大、睾酮水平低[分别为（28±8）比（22±4）岁，（2.0±1.3）比（5.4±4.3）nmol/L，t=3.044、-2.249；均P〈0.05]，虽然两组基础胰岛素水平和胰岛素分泌曲线下面积未见显著差异，但合并糖尿病的KS患者胰岛素抵抗指数较单纯KS患者明显增大（6.5±3.4比1.2±2.1，t=3.234，P〈0.05）；（3）KS合并糖尿病患者与单纯糖尿病患者相比，虽然75 g OGTT试验血糖和胰岛素水平一致，但身材更高、体重更重、低密度脂蛋白胆固醇水平更低[分别为（178±12）比（170±6）cm，（91±23）比（80±14）kg，（2.1±0.9）比（2.8±0.5）mmol/L，t=0.750、3.866、-2.681；P〈0.05]；（4）合并糖尿病的KS患者与单纯KS患者及单纯糖尿病患者相比，雌激素/雄激素比值（E/T）高，差异具有统计学意义（t=2.302、2.748；均P〈0.05）。结论（1）KS患者糖尿病发生率明显升高；（2）KS患者易发生糖代谢异常的病因可能包括年龄、睾酮水平低和卵泡刺激素水平高、高E/T值、胰岛素抵抗和X染色体数目异常等。ObjectiveTo evaluate the characteristics of glucose metabolism and the possible mechanisms of glucose metabolism disorder in patients with Klinefelter＇s syndrome （KS）.MethodsThis was a retrospective clinical research. The following data were collected and analyzed： the general condition, gonadotropic and gonadal hormone levels, lipid and glucose profiles, glucose and insulin levels after a 75 g oral glucose tolerance test, and homeostasis model assessment of insulin resistance （HOMA-IR） in 19 patients with KS alone, 9 patients with both KS and DM, 18 DM patients without KS; all were hospitalized in PLA General Hospital since 1990. Independent sample t test was used for comparison betneen two groups.Results（1） The incidence of DM in KS patients was 32.1% （9/28）; in patients with 47, XXY karyotype and 48, XXYY karyotype the incidence were 30.7% （8/26） and 50% （1/2）, respectively; （2） Compared with simple KS patients, patients with both KS and DM was significantly older, while the testosterone （T） level was significantly lower[ （28±8） vs （22±4） year, （2.0±1.3） vs （5.4±4.3） nmol/L, t=3.044, -2.249; all P〈0.05]; Although they had similiar fasting insulin level and area under the curve of insulin, KS patients complicated with DM presented a much higher insulin resistance index （6.5±3.4 vs 1.2±2.1, t=3.234, P〈0.05） ; （3） KS patients complicated with DM were much higher and heavier than simple DM patients[（178±12）vs（170±6） cm, （91±23）vs（80±14）kg, t=0.750, 3.866; P〈0.05]. The low-density lipoprotein concentration in patients with both KS and DM were lower than that of the patients with KS alone [（2.13±0.93）vs（2.85±0.50） mmol/L, t=-2.681; P〈0.05], but their glucose and insulin levels during an oral glucose load were not different between two groups; （4） The estradiol-to-testosterone ratio of KS patients complicated with DM was significantly higher than that of simple KS patients as well as simple DM patients （t=2.3

关 键 词：胰岛素抵抗 糖尿病 KLINEFELTER综合征 X染色体 睾酮 

分 类 号：R596.1[医药卫生—内科学]