天津医药

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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

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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