| Objective: To understand the abnormalities of blood glucose and glucose metabolism in iron overload patients with thalassemia major in this region and to explore the possible pathogenesis.Methods: A METHODS: A total of 102 patients diagnosed with β-thalassemia major by genetic testing at the Affiliated Hospital of Affiliated Hospital of Youjiang Medical University for Nationalities between January 01,2015 and October 01,2022 were collected for the study,and their serum ferritin(SF),fasting blood glucose(FBG),2h post-glucose load glucose,fasting Serum Insulin(FINS),Glycated Hemoglobin(HbAc1)and other indices.The Homeostatic Model of Membrane Island Beta Cell Function(HOMA-β)and Insulin Resistance Index(HOMA-IR)were calculated by the formula.The study subjects were divided into 4 groups according to age composition: 0～year-old group,5～year-old group,10～year-old group,and 18 and above age group.The subjects were grouped according to serum ferritin concentration: SF < 2500 μg/L group;2500 μg/L ≤ SF < 5000 μg/L group;SF ≥ 5000 μg/L group.Among them,39 patients with thalassemia major were further divided into groups with no glucose metabolism abnormalities in β-thalassemia major and with glucose metabolism abnormalities in β-thalassemia major according to the occurrence of glucose metabolism abnormalities.The clinical indicators related to glucose were compared between the groups.K independent samples non-parametric test and two-by-two comparison were used to compare the differences between clinical indicators among the groups.Correlation analysis between serum ferritin(SF)and glucose-related clinical indicators was performed using pearson correlation correlation analysis.Multiple linear stepwise regression analysis was used to assess the effect of blood glucose-related clinical indicators on SF,and regression equations were established.Results:(1)There was no statistically significant difference in gender,SF and fasting blood glucose among different age groups of 102 patients with thalassemia major(P>0.05);there was no statistically significant difference in age and gender among different SF groups(P>0.05),and there was no statistically significant difference in fasting blood glucose among different SF groups(P<0.001).There was a statistically significant difference in fasting blood glucose between SF≥5000 group and SF<2500 group and 2500≤SF<5000 group.The comparison of fasting blood glucose between SF≥5000 group and SF<2500 group and 2500≤SF<5000 group was statistically significant(P<0.001).The fasting blood glucose of SF≥5000 group(7.45mmol/L)was greater than that of SF<2500 group(5.29mmol/L).The difference between 2500≤SF<5000 group and SF≥5000 group was statistically significant(P <0.05),and fasting blood glucose in the SF≥5000 group(7.45mmol/L)was greater than that in the 2500 ≤ SF<5000 group(6.20mmol/L).(2)Among the 39 patients,33 cases of abnormal glucose metabolism occurred(84.6% accounting for 32.4% of the overall number),including 26 cases of impaired glucose tolerance(66.6%,accounting for 25.5% of the overall number)and 6 cases of diabetes mellitus(15.4% accounting for 5.9% of the overall number).The prevalence of glucose metabolism abnormalities in patients with β-thalassemia major increased gradually with serum ferritin concentration,with the prevalence of glucose metabolism abnormalities at 2500 μg/L ≤ SF <5000 μg/L being 75%,accounting for11.8% of the total number of patients;the prevalence of glucose metabolism abnormalities at SF ≥5000 μg/L was 95.2%,accounting for 19.6% of the total number of patients,and the prevalence of diabetes mellitus was The prevalence of diabetes mellitus was 28.5%,accounting for 5.9% of the total number of patients.(3)Glycosylated hemoglobin(HbAc1)in patients with β-thalassemia major did not reflect the glucose metabolism status of patients well,and the detection rate of glucose metabolism abnormalities in all age groups and all serum ferritin subgroups was not high for conventional cut-point glycosylated hemoglobin(HbAc1)≥6.5%.(4)The differences in fasting blood glucose,insulin resistance index and islet cell function index were statistically significant(P>0.05)when comparing between groups under the condition of gradually increasing serum ferritin concentration.fasting blood glucose(6.07 mmol/L)in the SF≥5000ug/L group was higher than fasting blood glucose(4.58mmol/L)in the 2500ug/L≤SF<5000ug/L group The insulin resistance index in the SF≥5000ug/L group(3.33)was higher than the insulin resistance index in the2500ug/L≤SF<5000ug/L group(2.60);the islet cell function index in the2500ug/L≤SF<5000ug/L group(208.58)was higher than that in the SF≥5000ug/L group(72.56).The differences in age,2h post-glucose load,fasting insulin and glycosylated hemoglobin between groups were not statistically significant(P>0.05),but the values of 2h post-glucose load and fasting insulin tended to increase gradually between groups.(5)Serum ferritin(SF)was positively correlated with fasting glucose,2h post-glycemic load glucose and insulin resistance index,and the correlation was negative with islet cell function index,and the correlation was statistically significant(P < 0.01).Conclusion:(1)Patients with iron overload in β-thalassemia major have a high risk of abnormal glucose metabolism,and the incidence increases gradually with the degree of iron overload,which requires increased clinical attention.(2)The potential mechanism of abnormal glucose metabolism in iron overload patients with β-thalassemia major may be related to the decrease in insulin resistance and insulin secretion function due to iron overload. |
