摘要
目的探讨2型糖尿病患者下丘脑-垂体-肾上腺(HPA)轴功能变化的临床意义。方法对127例2型糖尿病患者行口服糖耐量试验,并计算胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)、葡萄糖及胰岛素曲线下面积(AUCG,AUCI),同时检测患者血、尿皮质醇,血促肾上腺皮质激素(ACTH)等,将所得结果与65例健康体检正常者(对照组)进行比较。结果 (1)2型糖尿病患者中HPA轴功能紊乱率为22.8%(29/127),对照组为10.8%(7/65)。2型糖尿病患者多项HPA轴指标,包括8:00和16:00血皮质醇、日平均血皮质醇及尿游离皮质醇均高于对照组,差异均有统计学意义(P<0.05)。(2)伴HPA轴功能紊乱的2型糖尿病患者空腹血糖(FPG)、糖负荷2 h后血糖(2 h PPG)及AUCG均高于不伴HPA轴功能紊乱的患者(P<0.05)。剔除性别、年龄、BMI及腰围的影响,2型糖尿病患者8:00、16:00和24:00血皮质醇、日平均血皮质醇及尿游离皮质醇与FPG、2 h PPG及AUCG均呈正相关(P<0.05);多元逐步回归分析提示AUCG是影响8:00、16:00血皮质醇及日平均血皮质醇的独立相关因素;2 h PPG与24:00血皮质醇及尿游离皮质醇独立相关。结论 2型糖尿病患者HPA轴功能紊乱的患病率升高,2型糖尿病患者血糖升高与HPA轴功能紊乱互为因果。
Objective The purpose of the study is to look into the clinical significance of hypothalamo-pituitary-adrenal（HPA） axis abnormalities in patients with type 2 diabetes mellitus.Methods Oral glucose tolerance test（OGTT） was performed in 127 type 2 diabetic patients with the insulin index（ISI）,homeostatic model assessment-insulin resistance（HOMA-IR）,area under the curve of glucose（AUCG） and insulin（AUCI） calculated.At the same time,plasma cortisol,urinary cortisol,and plasma ACTH were detected in these patients with the results compared with those of 65 non-diabetic controls.Results（1）The prevalence of HPA axis abnormalities were 22.8%（29/127） in patients with type 2 diabetes mellitus and 10.8%（7/65） in normal controls.Indices of HPA axis function including plasma cortisol at 8：00 and at 16：00,daily average plasma cortisol and urinary free cortisol were higher in patients with type 2 diabetes than in controls（P〈0.05）.（2）Diabetic patients with HPA axis abnormalities displayed higher fasting plasma glucose（FPG）,2 h-postprandial plasma glucose（2 h PPG） and AUCG than patients without HPA axis abnormalities（P〈0.05）.After adjusted for sex,age,BMI and waist circumference,FPG,2 h PPG and AUCG were shown to be positively correlated with plasma and urinary cortisol levels（P〈0.05）.Multiariate stepwise regression analysis showed that AUCG was among the independent related factors of plasma cortisol at 8：00 and at 16：00 and daily average cortisol;2 h PPG was among the independent related factors of plasma cortisol at 24：00 and urinary free cortisol.Conclusion Our study indicates that patients with type 2 diabetes mellitus exhibit a significantly higher prevalence of HPA axis abnormalities.Glucose elevation and HPA axis abnormalities are reciprocal causations in patients with type 2 diabetes mellitus.
出处
《中国全科医学》
CAS
CSCD
北大核心
2011年第25期2881-2883,共3页
Chinese General Practice
