不同甲状腺手术方式对改善胰岛素抵抗的影响  

The effect of different thyroid surgery methods on improving insulin resistance

作　　者：王本泉 崔凡 邱钧 项本宏 Wang Benquan;Cui Fan;Qiu Jun;Xiang Benhong(Department of General Surgery,The First Peoples Hospital of Wuhu,Wuhu Anhui Province 241000,China;Department of Clinical Laboratory,The First Peoples Hospital of Wuhu,Wuhu Anhui Province 241000,China)

机构地区：[1]芜湖市第一人民医院普外科,安徽芜湖241000 [2]芜湖市第一人民医院检验科,安徽芜湖241000

出　　处：《中华普外科手术学杂志（电子版）》2024年第2期208-211,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2019年度安徽省科技惠民示范工程项目(201907d07050010);2023年度芜湖市科技局重点研发与成果转化项目(2023yf099)。

摘　　要：目的比较3种不同甲状腺切除术式对术后患者胰岛素抵抗的影响。方法回顾性分析2019年1月至2020年12月90例行甲状腺切除患者的临床资料,依据手术方式不同,将30例采用单侧腺瘤切除术患者设为A组,30例采用单侧甲状腺腺叶切除术患者设为B组,30例采用单侧甲状腺腺叶切除+对侧甲状腺部分切除术患者设为C组。采用SPSS 26.0统计软件进行数据分析。甲状腺激素及胰岛素抵抗相关指标以(x±s)表示,组间比较采用F检验,组内比较采用配对t检验。以P<0.05为差异有统计学意义。结果A、B、C三组切除甲状腺平均质量及占比比较:A组〈B组〈C组(P<0.05);三组患者甲状腺术后7 d及术后30 d三碘甲状腺原氨酸(T3)、甲状腺素(T4)、血清游离三碘甲腺原氨酸(FT3)、血清游离甲状腺素(FT4)水平低于术前,而促甲状腺激素(TSH)水平高于术前,术后7 d上述激素水平较术前比较差异有统计学意义(P<0.05);A、B、C三组,特别是C组,甲状腺术后7 d空腹血糖(FBG)、餐后2 h血糖(2h PG)、空腹胰岛素(FINS)、餐后2 h胰岛素(2h INS)、糖化血红蛋白(HbA1c)及胰岛素抵抗指数(HOMA-IR)低于术前(P<0.05)。结论切除甲状腺组织越多的甲状腺手术,降低甲状腺激素水平越明显,改善胰岛素抵抗效果越好。从外科学角度提出证据支持甲状腺激素水平和胰岛素抵抗之间存在正相关关系的基础理论。Objective To compare the effects of three different thyroidectomy methods on postoperative insulin resistance.Methods Clinical data of 90 patients undergoing thyroidectomy from January 2019 to December 2020 were retrospectively analyzed.Based on different surgical methods,30 patients undergoing unilateral adenoma resection were assigned to group A and 30 patients undergoing unilateral thyroidectomy were assigned to group B.Group C was assigned to 30 patients who underwent unilateral thyroidectomy+contralateral partial thyroidectomy.SPSS 26.0 statistical software was used for data analysis.Thyroid hormone and insulin resistance related indicators were expressed as(x±s),F test was used for inter-group comparison,and paired t test was used for intra-group comparison.P<0.05 was considered to be statistically significant.Results The average weight of thyroidectomy in groups A,B and C was compared with group A<group B<group C(P<0.05).The levels of triiodothyronine(T3),thyroxine(T4),serum free triiodothyronine(FT3)and serum free thyroxine(FT4)were lower than those before surgery,while the levels of thyrotropin(TSH)were higher than those before surgery.There were statistically significant differences in the above hormone levels at 7 days after operation compared with those before operation(P<0.05).The fasting blood glucose(FBG),2 h postprandial blood glucose(2h PG),fasting insulin(FINS),2 h postprandial insulin(2h INS),glycated hemoglobin(HbA1c)and insulin resistance index(HOMA-IR)in groups A,B and C,especially in group C,were lower than those before thyroid surgery(P<0.05).Conclusion The more thyroid tissue is removed,the more significant the reduction of thyroid hormone levels and the better the effect of improving insulin resistance.The basic theory of positive correlation between thyroid hormone levels and insulin resistance is supported by surgical evidence.

关 键 词：甲状腺结节 三碘甲状腺原氨酸 甲状腺素 促甲状腺素 胰岛素 胰岛素抗药性 

分 类 号：R653[医药卫生—外科学]