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低钾型周期性麻痹33例临床分析

张从艳1,刘维2,3   

  1. 1. 天津医科大学总医院内分泌科
    2.
    3. 天津医科大学总医院
  • 收稿日期:2010-10-20 修回日期:2010-12-28 出版日期:2011-04-15 发布日期:2011-04-15
  • 通讯作者: 张从艳

Clinical study on 40 hypokalemic periodic paralysis cases

  • Received:2010-10-20 Revised:2010-12-28 Published:2011-04-15 Online:2011-04-15

摘要: 摘要 目的:总结40例低钾型周期性麻痹(Hypokalemic periodic paralysis ,hypoPP)患者临床资料及标准口服葡萄糖(75 g)耐量试验(Oral glucose tolerance test,OGTT)结果特点,分析其发病因素。方法:回顾性分析40例hypoPP患者临床资料及其中33例患者OGTT结果。结果:40例患者均无明确hypoPP家族史,完善辅助检查(甲状腺功能、血气分析、尿酸化功能、RAAS系统、风湿免疫全项),排除了干燥综合征、肾小管酸中毒、Bartter综合征、原发性醛固酮增多症等排钾性内分泌疾病,发现并发甲状腺功能亢进症22例、亚临床甲减1例,余17例不合并其他内分泌疾病。33例hypoPP患者行口服糖耐量(OGTT)实验,与OGTT正常对照组比较,存在明显胰岛素抵抗,胰岛素水平较高。16例患者行三角肌活检免疫荧光检查示肌细胞膜大量免疫球蛋白沉积。结论:低钾型周期性麻痹可单独出现,也可合并甲状腺功能亢进症,甲亢和低钾周麻可先后出现于同一患者不同时期;低钾周麻患者无论合并甲亢与否,其血浆胰岛水平明显升高,存在胰岛素抵抗现象,肌细胞糖代谢异常及高胰岛素血症可能为其发病的重要原因。

关键词: 低钾型周期性麻痹, 胰岛素抵抗 , 高胰岛素血症

Abstract: Abstract Objective:To investigate the clinical features and OGTT results of 40 hypokalemic periodic paralysis cases. Methods:The clinical manifestations in 40 patients and OGTT results of 33 patients were analyzed and summarized. Results:40 patients had no clear hypoPP family history and they concurrent hyperthyroidism in 22 cases, subclinical hypothyroidism in 1 case and other 17 cases did not associated with any endocrine diseases after completing laboratory examinations .In comparison with the control,the OGTT results of 33 hypoPPs show a higher insulin level and insulin resistance. The deposition of immunoglobin on the muscle cell membrane in 16 cases was significantly increased. Conclusion:HypoPP can occur alone,also can concurrent hyperthyroidism. Hyperthyroidism and HypoPP can occur in a patient at the same time or in different periods . HypoPPs with or without hyperthyroidism have a higher insulin level and insulin resistance. Abnormal glucose metabolism and hyperinsulinemia may be one of the factors for disease.

Key words: Hypokalemic periodic paralysis , Insulin resistance, Hyperinsulinemia