原发性甲状旁腺功能亢进的糖代谢病理:流行病学和临床特征

E. Bibik, E. Dobreva, A. Eremkina, N. Mokrysheva
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引用次数: 0

摘要

原发性甲状旁腺功能亢进症(PHPT)不仅以矿物质代谢紊乱为特征,而且以人体其他代谢紊乱为特征。由于PHPT患者中心血管危险因素的频率增加,对这组患者的碳水化合物代谢病理的研究将有助于制定及时诊断和治疗的最佳方法。确定PHPT患者碳水化合物代谢紊乱的发生频率并描述其临床特征。材料和方法。对成人PHPT患者进行了单中心回顾性研究,评估了手术治疗前的矿物质和碳水化合物代谢的主要参数。排除标准为PHPT未缓解或甲状旁腺切除术后疾病复发;怀孕、哺乳。测定PHPT中各种碳水化合物代谢紊乱的发生频率、有和没有这些紊乱的患者矿物质参数的比较特征以及PHPT中2型糖尿病的严重程度。此外,还研究了各种代谢类型参数之间的潜在关系。该研究基于367名PHPT患者的临床信息,其中大多数患者有该病的症状形式。糖尿病前期疾病的总发病率为4.9% (95% CI: 3-8)。45例患者曾被诊断为2型糖尿病(12%,95% CI: 9-16),没有首次诊断为糖尿病的病例。碳水化合物代谢受损的个体体重指数较高,骨钙素值较低(27,2 [24,2;30,4] kg/m2 vs . 32,7 [28,1;39.4 kg/m2和48.1 [34;76,3] ng/mL vs . 33,1 [20,8];51,8] ng/mL,所有参数p< 0.001)。2型糖尿病患者中36例(80%)接受降糖治疗,其中14例接受二甲双胍单药治疗,8例接受包括二甲双胍在内的双组分治疗。5人接受胰岛素治疗。36.4%的患者诊断为糖尿病肾病,15.4%的患者有糖尿病视网膜病变的体征,61.9%的PHPT患者有糖尿病远端神经病变的症状。空腹血糖和糖化血红蛋白与骨代谢呈负相关,并依赖于肾小球滤过率。在PHPT患者中,2型糖尿病比一般人群更常见。可能的原因是胰岛素抵抗,这可能是由骨代谢物,主要是骨钙素的影响引起的。在大多数情况下,二甲双胍可以实现对PHPT患者糖尿病的补偿。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pathology of carbohydrate metabolism in primary hyperparathyroidism: epidemiological and clinical characteristics
Primary hyperparathyroidism (PHPT) is characterized by disorders of not only mineral metabolism, but also other kinds of the human metabolism. Due to the increased frequency of cardiovascular risk factors among patients with PHPT, the study of the carbohydrate metabolism pathology in this cohort of patients will allow developing optimal approaches to their timely diagnosis and treatment.Aim. To determine the frequency and describe the clinical features of carbohydrate metabolism disorders in patients with PHPT.Material and methods. A single-center retrospective study of adults with PHPT was carried out with an assessment of the main parameters of mineral and carbohydrate metabolism before surgical treatment of the disease. The exclusion criteria were the absence of PHPT remission or a recurrence of the disease after parathyroidectomy; pregnancy, lactation. The frequency of various disorders of carbohydrate metabolism in PHPT, the comparative characteristics of mineral parameters in patients with and without them, as well as the severity of type 2 diabetes mellitus in PHPT were determined. In addition, potential relationships between the parameters of various types of metabolism have been studied.Results. The study was based on a clinical information of 367 patients with PHPT, most of whom had a symptomatic form of the disease. The overall incidence of prediabetic disorders was 4,9% (95% CI: 3-8). Type 2 diabetes mellitus was previously diagnosed in 45 patients (12%, 95% CI: 9-16), there were no cases of first diagnosed diabetes mellitus. Individuals with impaired carbohydrate metabolism had a statistically significantly higher body mass index and lower values of osteocalcin (27,2 [24,2; 30,4] kg/m2 vs 32,7 [28,1; 39,4 kg/m2 and 48,1 [34; 76,3] ng/mL vs 33,1 [20,8; 51,8] ng/mL, respectively, for all parameters p<0,001). Among patients with type 2 diabetes mellitus, 36 people (80%) took hypoglycemic therapy, 14 of which received metformin monotherapy and 8 received two-component therapy, including metformin. 5 people were on insulin therapy. Diabetic nephropathy was diagnosed in 36,4% of patients, 15,4% had signs of diabetic retinopathy, symptoms of diabetic distal neuropathy were observed in 61,9% of patients with PHPT. Fasting glucose and glycated hemoglobin were negatively correlated with bone metabolism, and also expectedly depended on the glomerular filtration rate.Conclusion. Among patients with PHPT, type 2 diabetes mellitus is more common than in the general population. The likely reason of this may be insulin resistance, that can be caused by the effects of bone metabolites, primarily osteocalcin. In most cases, metformin makes it possible to achieve compensation for diabetes mellitus in PHPT.
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