| ObjectiverTo investigate the glucose metabolism of the patients with Graves 'disease(GD) and determine their fasting serum insulin-like growth factor binding protein-1 (IGFBP-1) and free insulin-like growth factor-1 (IGF-1), and to evaluate their roles in glucose metabolism disorder of GD.Methods:GD patients and healthy controls underwent oral glucose tolerance test(OGTT).Determine their blood glucose and insulin respectively. Fasting blood FT3,FT4, TSH, TPOAb, IGFBP-1,free IGF-1 were measured. Blood glucose was determined by glucose oxidase method;Insulin,FT3,FT4, TSH,TPOAb were determined by immunochem-iluminometric assay. Serum IGFBP-1 and free IGF-1 levels were determined by ELISA .Divide the GD patients into normal glucose tolerance(NGT) group, impaired glucose homeostasis(IGH)(including impaired fasting glucose (IFG)and impaired glucose tolerance(IGT)) group and diabetes mellitus(DM) group according to their results of OGTT. Insulin resistance index(HOMA-IR),insulinsensitivity index (ISI), the areas under blood glucose curve(AUC-PG) and insulin curve(AUC-INS) were calculated and compaired with that of normal controls.Results: (l)There are about 60% of GD patients had glucose intolerance. (29.41% with IGH,30.59% with DM diagnosis); These results demonstrated that most of GD patients exist glucose metabolism disorder .2.1n GD patients,from NGT,IGH to DM group,the fasting serum IGFBP-1 levels increased gradualy(51.97+27.91ng/ml, 61.24+30.49ng/ml,67.26+22.44ng/ml).They were higher than that of controls significantly ( 20.95 + 8.95ng/ml ) ( PO.001 respectively); From NGT,IGH to DM group, fasting free IGF-1 levels decreased gradualy (1.28 + 0.56 ng/ml,1.05+0.52ng/ml, 0.84+0.38ng/ml),In IGH and DM group, free IGF-1 levels were less than that of controls (1.46 +0.53ng/ml) (P<0.001 respectively) ,NGT group had no significant difference with controls (P>0.05).3.In GD patients, from NGT,IGH to DM group, AUC-PG and AUC-INS increased gradualy (AUC-PG: 19.36 + 3.31mmol.h-1L-1, 24.60+3.43 mmol.h+ 6.83mmol.h-1L-1; AUC-INS:98.41+43.27mIU.h-1L-1, 107.06 + 39.76mIU.h-|L-1,l 16.17 + 53.nmlU.h-1L-1 ). AUC-PG and AUC-INS in IGH,DM group were higher than that of controls (AUC-PG-.18.69 + 2.78 mmol.h-1L-1, AUC-INS:79.86 + 24.91mIU.h-1L-1) (PO.05 respectively ), NGT group had no significant difference with controls (P>0.05).4.HOMA-IR of each group increased gradualy(2.31 + 1.47,3.18+1.47,3.98+1.55),IGH and DM group were higher than that of controls significantly ( 2.13 + 0.61 )( P=0.006,P<0.001 ) .NGT group had no significant difference with controls (P>0.05). ISI of each group decreased gradualy(-3.79+0.55,-4.17+0.46,-4.43+0.36),IGHandDM group were less than that of controls significantly (-3.82+ 0.32) (P=0.006, PO.001), NGT group had no significant difference with controls (P>0.05).These results demonstrated that insulin resistance were more and more serious from NGT to IGH and DM group.5.In all these people,fasting IGFBP-1 were correlated with FT3 and FT4 positively (r=0.741,P<0.001; r=0.676, P<0.001),and correlated negitively with TSH (r = -0.445, P<0.001);It showed that thyroid hormone(TH) can stimulate the production of IGFBP-1. Fasting IGFBP-1 was correlated with PPG, 2hPG and AUC-PG (r=0.318, P=0.001;r=0.368, P<0.001;r=0.396, PO.001). It demonstrated that IGFBP-1 had influence on the increase of blood glucose.Conclusion: l.Most of GD patients had glucose metabolism disorder.Some of them even met the DM diagnosis.The glucose metabolism disorder of GD patients was related to insulin resistance.2.In GD patients ,the fasting IGFBP-1 increased,free IGF-1 decreased.The increase of IGFBP-1 was due to the stumili of increased thyroid hormone.3. The insulin resistance of GD patients was related to the increase of IGFBP-1 and the decrease of free IGF-1,which was paralleled with the insulin resistance.lt demonstrated thatIGFBP-1 and free IGF-1 had influence on the glucose metabolism in GD patients.
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