The Study About The Relationship Between Nontransfusion-dependent Thalassaemia And Glycometabolism

Objective To understand the glucose metabolism status and the effect of iron overload on the islet function in patients with with NTDT in Guangxi.Methods Total 179 NTDT patients (102 males and 77 females; 152 adult and 54 children) from 2013 to 2015 participated in our study,the average age of adult was 31.0±45 years.The average age of children was 11.95±3.92 years.Oral glucose tolerance test (OGTT) were performed respectively.The patients were divided into three groups based on FPG and 2-h plasma glucose levels(NGT:FPG<6.1 mmol / L and PG120<7.8 mmol / L, n =120;hypoglycemia group:FPG < 2.8mmol/L PG120 < 2.8mmol/L, n = 30;high glucose group:FPG?6.1 mmol / L and PG120?7.8 mmol / L,n = 29),and multiple comparisons of each group.According to the level of SF, we divided into normal group (SF < 1000ng /ml, n=87), mild iron overload group(SF:1000-1500ng/ml, n=17), moderate iron overload group (SF:1500-2500ng/ml,n = 30) and severe iron overload group (? 2500ng/ml, n = 20), and in each group are pairwise comparison,and compared the each groups.Besides we also divided into three groups based on LIC(normal group:?3.2mg/g, n =16; Mild liver iron overload group:3.2-7mg/g, n ? 20 ; Moderate liver iron overload group :LIC:7-15mg/g, n ? 26; Severe liver iron overload group: > 15mg/g, n = 31),and multiple comparisons of each group.Using serum glucose after oxidase method to detect fasting plasma glucose (FPG), 30min glucose, 2 hour blood glucose, radio immunity analysis method was used to detect the fasting insulin(fins), and insulin for 30 min, 2 h insulin, and calculated the Homa insulin resistance index (HOMA-IR) and homeostasis model assessment insulin secretion index (HOMA) insulin ensitive index (IAI), ?I30/?G30??I120/?G120.Serum ferritin was measured by electrochemiluminescence immunoassay (ECLIA) in patients.Liver iron was measured by MRI R2 in patients.Results1? Total 179 NTDT patients (102 males(56.98%)and 77 females(43.02%);152 adult ( 69.83%) and 54 children (30.17%) in our study.The average age of 67 male adult patients was 31.49±9.67 years old.The average age of the 58 female adults was 30.43 ± 9.26 years.The average age of 35 male children patients was 11.27 ± 3. 89 years old.The average age of the 19 female children was 13.21 ±3.77 years.In 54 children patients, 51 patients measured height, Mean BMI16.45+ 2.59 Kg/m2,There were 23 patients (45.10%) with Microsomia.2? There were 3 diabetes (1.68%) ,30(16.76%) patients with hypoglycemia ,0 patients with impaired fasting glucoseand ,and 26(14.53%) patients with impaired glucose tolerance in the NTDT patients.3?154 NTDT patients with SF monitoring , the median value of SF was 802.04ng/ml.There were 17 (11.04%) patients with mild iron overload , 30(19.48%) patients with moderate iron overload, and 20 (12.99%) patients had severe iron overload.In 93 NTDT patients who underwent LIC examination, the median value of LIC was 10mg/g.There were 20(21.51%) patients with Mild liver iron overload, 26 (27.96%) patients with Moderate liver iron overload group,and 31 (33.33%)patients with severe liver iron overload.4.Group according to SF,mild to moderate iron overload patients (SF <2500ng/ml) blood glucose abnormalities mainly manifested as hypoglycemia(23.40%),The incidence of hypoglycemia was increased in patients with normal ferritin (16.09%),In patients with severe iron overload (SF > 2500ng/ml) the high incidence of abnormal glucose (45.00%), mainly for high blood glucose(IGT, DM) was significantly higher than the normal ferritin (12.64%) (P <0.01);Group according to LIC, In the Mild and moderate and severe liver iron overload group (liver iron 3.2 ? 15mg/g) (28.26%) the incidence of hypoglycemia and liver iron in patients with normal group (31.25%) is similar,Both significant differences, and severe liver iron overload (liver Fe >15mg / g) in patients with high blood sugar (IGT and DM) incidence rate is high(35.48%), was significantly higher than that in patients with liver iron is less than or equal to 3.2mg/g) (0) (P < 0.01).5?The patients with SF, the age of moderate iron overload group and severe iron overload group was significantly higher than that in the normal group, the difference was statistically significant (P < 0.05).The levels of LIC in mild ?moderate and severe iron overload group were significantly higher than those in the normal group (P < 0.05).The blood glucose of 2 hours insevere iron overload group was higher than that in normal group and moderate iron overload group (P< 0.01).The age of severe liver iron overload group was significantly higher than that of the normal group (P < 0.01).The level of SF in the severe liver iron overload group was higher than that in the normal group, mild and moderate liver iron overload group (P < 0.01). The 2 hours blood sugar of severe liver iron overload group were higher than the normal group and the moderate group (P <0.05). Severe group 30min insulin levels, ?I30/?G30 were lower than the normal group (P < 0.01).Conclusions1? The manifestations of the glycometabolism in patients with NTDT in Guangxi were hypoglycemia, IGT, DM.2?Iron overload resulting in postprandial hyperglycemia by reduce the first phase of islet secretion in NTDT patients.