Liang L Y, Lao W Q, Meng Z, Zhang L N, Hou L L, Ou H, Liu Z L, He Z W, Luo X Y, Fang J P
Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Zhonghua Er Ke Za Zhi. 2017 Jun 2;55(6):419-422. doi: 10.3760/cma.j.issn.0578-1310.2017.06.005.
This study aimed at determining the characteristics of the glucose homeostasis and its relationship with iron overload of the patients with β-thalassemia major (β-TM). From Sun Yat-sen Memorial Hospital between January 2014 and December 2015, a total of 57 transfusion-dependent β-TM patients with 5-18 years old were enrolled in this study and fasting blood glucose(FBG) and insulin level, serum ferritin (SF), serum iron, transferrin, total iron binding capacity, unsaturated iron binding capacity were determined.Insulin resistance index (IRI), insulin sensitivity index and β-cell function index (BFI) were also estimated. Besides, in 36 patients cardiac T2* and liver T2* were estimated. (1) Four patients(7%) with β-TM were diagnosed diabetes mellitus, and 14(24%) had impaired fasting glucose. (2) The incidence of abnormal glucose metabolism was significantly different according to levels of SF and degrees of the cardiac iron overload(χ(2)=9.737, <0.05; χ(2)=17.027, <0.05). It rose while the level of SF increased and the degree of cardiac iron overload aggravated. (3) The incidence of abnormal glucose level was not significantly different in cases with different degree of liver iron overload.The severe group of liver iron overload had significantly higher levels of INS, HOMA-βFI, HOMA-ISI, HOMA-βFI than the non-severe group (=-2.434, -2.515, =8.658, all <0.05), while no differences were found in the level of FBG, HOMA-βFI between two groups. (4) The result of logistic regression analysis indicated that the cardiac T2* was a significant predictor for the incidence of abnormal glucose metabolism in TM patients (=0.035, =1.182%, 95%=1.048 to 1.332). The high prevalence of abnormal glucose metabolism in β-TM patients was mainly closely related with the internal iron overload, especially in organs.The cardiac T2* was an independent risk factor for the incidence of abnormal glucose metabolism in TM patients.
本研究旨在确定重型β地中海贫血（β-TM）患者葡萄糖稳态的特征及其与铁过载的关系。2014年1月至2015年12月期间，中山大学附属孙逸仙纪念医院共有57例年龄在5至18岁之间的输血依赖型β-TM患者纳入本研究，测定了空腹血糖（FBG）、胰岛素水平、血清铁蛋白（SF）、血清铁、转铁蛋白、总铁结合力、不饱和铁结合力。还估算了胰岛素抵抗指数（IRI）、胰岛素敏感性指数和β细胞功能指数（BFI）。此外，对36例患者进行了心脏T2和肝脏T2测定。（1）4例（7%）β-TM患者被诊断为糖尿病，14例（24%）空腹血糖受损。（2）根据SF水平和心脏铁过载程度，葡萄糖代谢异常的发生率有显著差异（χ(2)=9.737，<0.05；χ(2)=17.027，<0.05）。随着SF水平升高和心脏铁过载程度加重，发生率上升。（3）不同程度肝脏铁过载患者的血糖异常发生率无显著差异。肝脏铁过载严重组的INS、HOMA-βFI、HOMA-ISI、HOMA-βFI水平显著高于非严重组（=-2.434，-2.515，=8.658，均<0.05），而两组间FBG、HOMA-βFI水平无差异。（4）逻辑回归分析结果表明，心脏T2是TM患者葡萄糖代谢异常发生率显著的预测指标（=0.035，=1.182%，95%=1.048至1.332）。β-TM患者葡萄糖代谢异常的高患病率主要与体内铁过载密切相关，尤其是在器官中。心脏T2是TM患者葡萄糖代谢异常发生率独立的危险因素。
