2型糖尿病患者肾上腺皮质功能的昼夜变化及影响因素

Diurnal functional changes of adrenal cortex in patients with type 2 diabetes and the influencing factors

目的:分析2型糖尿病患者肾上腺皮质功能的变化及其相关因素,以期发现对其介入康复干预措施的可能性。方法:宁夏医学院附属医院进行体检检查确定的健康人30例(正常对照组),经糖耐量试验及正规体检,排除糖尿病及其他系统慢性疾病的存在;3个月内无外伤、感染、发热等应激状况。男18例,女12例。就诊于宁夏医学院附属医院门诊与住院部的2型糖尿病患者91例(2型糖尿病组),男58例,女33例。入选患者均经1999年世界卫生组织诊断标准确诊的2型糖尿病患者;病史均>1年;无明显肾功能、肝功能异常者;排除近3个月内有外伤、感染、发热等应激状况患者;排除有过敏,正在使用激素治疗患者;排除在服用除口服降糖药物和胰岛素的患者。2型糖尿病组分为两个亚组:合并慢性并发症组53例,男32例,女21例。未合并慢性并发症组38例,男26例,女12例。分别送检空腹血糖、三酰甘油、总胆固醇、糖化血红蛋白、血皮质醇和血醛固酮;餐后2h血糖;于下午16:00采取同侧肘静脉血,送检血皮质醇。结果:91例2型糖尿病患者8:00皮质醇观测值为(222.0±74.0)μg/L,16:00皮质醇观测值为(134.0±63.0)μg/L;正常对照组8:00皮质醇观测值为(105±67)μg/L,16:00皮质醇观测值为(63±31)μg/L;2型糖尿病组明显高于正常对照组(t=2.33,P<0.05),同时发现在2型糖尿?

AIM: To analyze the functional changes and relative factors of adrenal cortex in patients with type 2 diabetes for discovering interventional rehabilitative measures. METHODS: Thirty healthy examiners(18 men and 12 women) in the Affiliated Hospital of Ningxia Medical College(normal control group) were selected. After sugar tolerance experiment and normal health exanimation, they were excluded to have diabetes and chronic systematic diseases. They had no trauma, infection and febrile in 3 months.Totally 91 patients with type 2 diabetes(58 men and 33 women) in the Out-patient clinic and Patient Department in the Affiliated Hospital of Ningxia Medical College (type 2 diabetes group). The subjects were in accordance with the diagnosis standard of World Health Organization in 1999.They were having disease more than 1 year; without obvious kidney and liver dysfunction, without trauma, infection and febrile in 3 months, without sensitivity, without using hormone treatment; without oral antidiabetic drug and insulin. Patients in the type 2 diabetes group were divided into two subgroups: united chronic complication group(n=53), including 32 men and 21 women; and ununited chronic complication group (n=38), including 26 men and 12 women. Fasting blood sugar, triacylglycerol (TG), total cholesterol (TC), sugar ferrohemoglogin, blood cortisol and aldosterone of subjects were examined. Blood sugar 2 hours after meals were examined. Elbow venous blood in the single side was collected at 16:00 pm, and the blood cortisol was examined. RESULTS: The blood cortisol value of 91 type 2 diabetes patients at 8:00 was (222.0±74.0)μg/L, and that at 16:00 was (134.0±63.0)μg/L; The blood cortisol value of controls at 8:00 was (105±67)μg/L, and that at 16:00 was (63±31)μg/L. The blood cortisol in the type 2 diabetes group was significantly higher than that in the normal control group, which showed significant difference(t=2.33,P< 0.05).At the same time, blood cortisol lessened at day and night of the patients in the type 2 diabetes group even disappeared. The blood cortisol value of patients in the united chronic complication group at 8:00 and 16:00 was significantly higher than that of patients in the ununited chronic complication group (t=2.02, 2.16, P< 0.05).The mean value of blood aldosterone of patients in the type 2 diabetes group was lower than that of patients in the normal control group. It was indicated from monofactor correlation analysis on aldosterone that blood aldosterone value was correlated with ill course, blood sugar control and telescope degree and urine microalbumin. CONCLUSION: The blood cortisol excretion of patients with type 2 diabetes is increased, and the blood aldosterone is decreased. This results in the abnormality of blood and fat metabolism as well as the increasing rate of complications.