·糖尿病临床研究·

　　王丽华 刘伟 李圣贤 黄融 蔡懿婷 陈雅雯

　　基金项目：国家自然科学基金资助项目(30570882)

　　作者单位：200127 上海， 上海交通大学医学院附属仁济医院内分泌科

　　通讯作者：刘伟，E-mail：sue_liuwei@163.com

　　【摘要】 目的 探讨2型糖尿病(T2DM)患者皮质醇分泌和下丘脑-垂体-肾上腺(HPA)轴活性的改变。 方法 选取2型糖尿病患者114例(T2DM组)和17例单纯向心性肥胖患者、正常对照80名(NC组)，T2DM组再按腰围分为肥胖组和非肥胖组，比较4组皮质醇分泌水平和HPA轴活性。 结果 4组患者皮质醇基础水平无差异;用地塞米松后T2DM+OB组女性患者皮质醇被抑制程度较NC组少(P<0.05);与T2DM+OB组、NC组比较，T2DM组患者肾上腺被兴奋程度最高，尤其在男性(P<0.05)。 结论 不同体脂分布、不同性别T2DM患者存在HPA轴活性的差异。

　　【关键词】糖尿病，2型;皮质醇;HPA轴

　　doi:10.3969/j.issn.1006-6187.2011.08.013

　　The changes in the cortisol secretion and regulation in the patients with type 2 diabetes

　　WANG Li-hua, LIU Wei, LI Sheng-xian, et al. Department of Endocrinology and Metabolism, Renji Hospital, Shanghai Jiaotong University, Shanghai 200127, China

　　Corresponding author：LIU Wei, E-mail: sue_liuwei@163.com

　　【Abstract】 Objective To investigate the changes in cortisol secretion and the activities of hypothalamo-pituitary-adrenal (HPA) axis in type 2 diabetic patients. Methods 114 T2DM patients and 101 healthy subjects as controls were seclected and subdivided each group into central obese and nonobese subgroups according to whether waist was greater than 90 cm in men and 80 cm in women. We measured their plasma and uric cortisol and performed dexamethasone suppression test and ACTH (cosyntropin) stimulation test. Results There were little basal cortisol secretion differences among the four groups.The plasma cortisol level of females after dexamethasone suppression test was higher in obese diabetic patients (P<0.05) than in nonobese diabetic patients.

　　Conversely, serum cortisol profile after ACTH1-24 stimulation were increased significantly in no-obese diabetes patients(P<0.05), particully in males. Conclusions In type 2 diabetes, the activity of HPA is different between males and females in obese patients versus no-obese patients.

　　【Key words】Diabetes mellitus, type 2; Cortisol; HPA axis