《中国糖尿病杂志》官方网站

20

您的位置:首页 > 中国糖尿病杂志 > 2014年 > 11期

 高血糖患者皮质醇分泌情况

来自:中国糖尿病杂志  编辑:张炜 张征 徐尔理|点击数:|2014-11-24

 糖尿病与肥胖、脂质代谢

  【摘要】目的 探讨高血糖患者皮质醇的分泌情况。方法 对222例高血糖患者行OGTT,并计算胰岛素敏感指数(ISI)、稳态模型评估胰岛素抵抗指数(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例非高血糖正常者(对照组)进行比较。结果 (1)高血糖患者中高皮质醇分泌者为20.3%(45/222),对照组为10.8%(7/65)。高血糖患者08:00[(335.7±90.7)vs (297.3±77.6)nmol/L]及16:00血皮质醇[(203.1±67.5)vs (177.7±48.4)nmol/L]、日平均血皮质醇[(208.9±62.2)vs(187.4±49.0 )nmol/L)]及尿游离皮质醇[(77.9±39.1) vs (65.5±16.1)μg/24 h)]均高于对照组。(2)伴高皮质醇分泌的糖尿病患者FPG,[(10.8±3.7)vs(7.8±1.7) mmol/L]、2 hPG[(18.7±5.3)vs(13.9±3.3)mmol/L]及AUCG[(2980±860)vs (2287±433)]高于正常皮质醇分泌的糖尿病患者,ISI则低[(-4.8±0.8) vs( -4.2±0.9)];伴高皮质醇分泌的糖调节受损患者AUCG高于正常皮质醇分泌的患者[(1742±155) vs (1585±153)]。(3)高血糖患者FPG、2 hPG及AUCG等与血、尿皮质醇水平相关;多元逐步回归分析提示,FPG、2 hPG及AUCG是影响08:00、16:00血皮质醇及夜间皮质醇占清晨分泌量百分比(F%)的独立相关因素。结论 高血糖患者高皮质醇分泌的发生率升高,患者血糖升高与高皮质醇分泌互为因果。

  【关键词】高血糖;糖尿病;HPA轴;皮质醇

  【Abstract】Objective The purpose of the study was to look foro investigate the secretion of cortisol in hyperglycemic patients. Methods Two hundreds and twenty-two hyperglycemic patients were performed OGTT, and insulin sensitivity index (ISI), HOMA IR, areas under the curve of glucose (AUCG) and insulin (AUCI) were calculated, and the plasma and urinary cortisol, plasma ACTH of patients were detected. The results obtained were compared with those of 65 non-hyperglycemic normal patients (the control group). Results (1) The percentage of patients with secretion of cortisol was 20.3% (45/222) in hyperglycemic patients and 10.8% (7/65) in control group. The plasma cortisol at 08:00 [(335.7±90.7) vs (297.3±77.6) nmol/L] and 16:00 [(203.1±67.5) vs (177.7±48.4) nmol/L] in hyperglycemic patients, daily average plasma cortisol [(208.9±62.2) vs (187.4±49.0) nmol/L] and urinary-free cortisol [(77.9±39.1) vs (65.5±16.1) μg/24 h] were higher than those of control group. (2) The fasting plasma glucose (FPG) [(10.8±3.7) vs (7.8±1.7) mmol/L], 2 hours post-prandial plasma glucose (2 hPG) [(18.7±5.3) vs (13.9±3.3) mmol/L] and AUCG [(2980±860) vs (2287±433)] in diabetic with high cortisol secretion were higher than those of patients with normal secretion, and the ISI [(-4.8±0.8) vs (-4.2±0.9)] was lower. The impaired glucose regulation patients with increased secretion of cortisol had higher AUCG than that of normal secretion patients [(1742±155) vs (1585±153)]. (3) The FPG, 2 hPG and AUCG in hyperglycemia patients were correlated with plasma and urinary cortisol levels. The multiple stepwise regression analysis suggested that FPG, 2 hPG and AUCG were the independent related factors affecting the percentage (F%) of plasma cortisol at 08:00, 16:00 and cortisol at night in the secretory volume of morning cortisol. Conclusions The incidence of high cortisol secretion is elevated in hyperglycemic patients. The elevation of blood glucose and high secretion of cortisol in patients were cause and effect of each other.

  【Key words】Hyperglycemia; Diabetes mellitus; HPA axis; Cortisol

上一篇:2型糖尿病患者龈沟液中基质金属蛋白酶-1的检测和临床意义 下一篇:2型糖尿病患者脑源性神经营养因子表达的变化及其临床意义