改善伴发糖尿病前期的血钙正常型原发性甲状旁腺功能亢进症甲状旁腺切除术后的血糖稳态。
Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes.
机构信息
Division of Endocrinology and Metabolism, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54621 Thessaloniki, Greece.
Division of Geriatric Medicine, Department of Neuroscience, Angers University Hospital, 49035 Angers, France.
出版信息
Nutrients. 2020 Nov 16;12(11):3522. doi: 10.3390/nu12113522.
We have previously described increased fasting plasma glucose levels in patients with normocalcemic primary hyperparathyroidism (NPHPT) and co-existing prediabetes, compared to prediabetes per se. This study evaluated the effect of parathyroidectomy (PTx) (Group A), versus conservative follow-up (Group B), in a small cohort of patients with co-existing NPHPT and prediabetes. Sixteen patients were categorized in each group. Glycemic parameters (levels of fasting glucose (fGlu), glycosylated hemoglobin (HbA1c), and fasting insulin (fIns)), the homeostasis model assessment for estimating insulin secretion (HOMA-B) and resistance (HOMA-IR), and a 75-g oral glucose tolerance test were evaluated at baseline and after 32 weeks for both groups. Measurements at baseline were not significantly different between Groups A and B, respectively: fGlu (119.4 ± 2.8 vs. 118.2 ± 1.8 mg/dL, = 0.451), HbA (5.84 ± 0.3 %vs. 5.86 ± 0.4%, = 0.411), HOMA-IR (3.1 ± 1.2 vs. 2.9 ± 0.2, = 0.213), HOMA-B (112.9 ± 31.8 vs. 116.9 ± 21.0%, = 0.312), fIns (11.0 ± 2.3 vs. 12.8 ± 1.4 μIU/mL, = 0.731), and 2-h post-load glucose concentrations (163.2 ± 3.2 vs. 167.2 ± 3.2 mg/dL, = 0.371). fGlu levels demonstrated a positive correlation with PTH concentrations for both groups (Group A, rho = 0.374, = 0.005, and Group B, rho = 0.359, = 0.008). At the end of follow-up, Group A demonstrated significant improvements after PTx compared to the baseline: fGlu ((119.4 ± 2.8 vs. 111.2 ± 1.9 mg/dL, = 0.021) (-8.2 ± 0.6 mg/dL)), and 2-h post-load glucose concentrations ((163.2 ± 3.2 vs. 144.4 ± 3.2 mg/dL, = 0.041), (-18.8 ± 0.3 mg/dL)). For Group B, results demonstrated non-significant differences: fGlu ((118.2 ± 1.8 vs. 117.6 ± 2.3 mg/dL, = 0.031), (-0.6 ± 0.2 mg/dL)), and 2-h post-load glucose concentrations ((167.2 ± 2.7 vs. 176.2 ± 3.2 mg/dL, = 0.781), (+9.0 ± 0.8 mg/dL)). We conclude that PTx for individuals with NPHPT and prediabetes may improve their glucose homeostasis when compared with conservative follow-up, after 8 months of follow-up.
我们之前描述过，与单纯的糖尿病前期相比，患有血钙正常型原发性甲状旁腺功能亢进症（NPHPT）和并存的糖尿病前期的患者空腹血糖水平升高。本研究评估了甲状旁腺切除术（PTx）（A 组）与保守随访（B 组）对伴有 NPHPT 和糖尿病前期的小队列患者的影响。每组分为 16 名患者。在基线和 32 周时评估了两组的血糖参数（空腹血糖（fGlu）、糖化血红蛋白（HbA1c）和空腹胰岛素（fIns）水平）、胰岛素分泌稳态模型评估（HOMA-B）和抵抗（HOMA-IR）以及 75 克口服葡萄糖耐量试验。A 组和 B 组的基线测量值无显著差异：fGlu（119.4 ± 2.8 与 118.2 ± 1.8 mg/dL， = 0.451）、HbA（5.84 ± 0.3%与 5.86 ± 0.4%， = 0.411）、HOMA-IR（3.1 ± 1.2 与 2.9 ± 0.2， = 0.213）、HOMA-B（112.9 ± 31.8 与 116.9 ± 21.0%， = 0.312）、fIns（11.0 ± 2.3 与 12.8 ± 1.4 μIU/mL， = 0.731）和 2 小时负荷后血糖浓度（163.2 ± 3.2 与 167.2 ± 3.2 mg/dL， = 0.371）。两组的 fGlu 水平与 PTH 浓度呈正相关（A 组，rho = 0.374， = 0.005，B 组，rho = 0.359， = 0.008）。在随访结束时，与基线相比，A 组在 PTx 后显示出显著改善：fGlu（（119.4 ± 2.8 与 111.2 ± 1.9 mg/dL， = 0.021）（-8.2 ± 0.6 mg/dL））和 2 小时负荷后血糖浓度（（163.2 ± 3.2 与 144.4 ± 3.2 mg/dL， = 0.041）（-18.8 ± 0.3 mg/dL））。对于 B 组，结果表明无显著差异：fGlu（（118.2 ± 1.8 与 117.6 ± 2.3 mg/dL， = 0.031）（-0.6 ± 0.2 mg/dL））和 2 小时负荷后血糖浓度（（167.2 ± 2.7 与 176.2 ± 3.2 mg/dL， = 0.781）（+9.0 ± 0.8 mg/dL））。我们得出结论，与保守随访相比，甲状旁腺切除术可能会改善伴有 NPHPT 和糖尿病前期的患者的葡萄糖稳态，随访 8 个月后。
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