糖尿病患者高血糖与皮质醇分泌状况的关系

Relationship between secretion of cortisol and higher blood glucose in patients with diabetes mellitus

目的研究糖尿病患者的皮质醇分泌状况,探讨其与高血糖之间的关系。方法139例糖尿病患者(糖尿病组)行口服糖耐量试验(OGTT),计算胰岛素敏感指数(ISI)、HOMA指数(HOMAIR)、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,以及血促肾上腺皮质激素(ACTH)等分泌情况。以52例非糖尿病健康者作为对照(对照组)。结果糖尿病组中高皮质醇分泌患者所占比例显著高于对照组(25.2%vs11.5%)(P<0.05)。糖尿病组08:00血皮质醇、16:00血皮质醇、日平均血皮质醇及尿游离皮质醇检测值均显著高于对照组(P<0.05)。糖尿病组中,伴高皮质醇分泌患者的空腹血糖(FPG)、糖负荷2h后血糖(2hPPG)、AUCg及HOMAIR均明显高于皮质醇正常分泌患者(P<0.05)。剔除性别、年龄、体质量指数及腰围的影响,FPG、2hPPG、AUCg、ISI及HOMAIR等与血、尿皮质醇水平相关。结论糖尿病患者高皮质醇分泌的患病率升高,其血糖升高与高皮质醇分泌互为因果。

Objective To observe the secretion of cortisol in patients with diabetes mellitus, and investigate its relationship with higher blood glucose. Methods One hundred and thirty-nine patients with diabetes mellitus （diabetes mellitus group） were performed oral glucose tolerance test （OGTT） , and insulin index （ISI） , HOMA IR, area under the curve of glucose （AUCg） and insulin （AUCi） were calculated. All of the patients were measured plasma cortisol, urinary cortisol and plasma adrenocorticotropic hormone （ACTH）. Fifty-two healthy individuals without diabetes mellitus were served as control group. Results The prevalence of increased secretion of cortisol was significantly higher in diabetes mellitus group than control group（25.2% vs 11. 5%, P 〈0.05）. The plasma cortisol of 08：00 and 16：00 time point, daily average cortisol and urinary free cortisol were significantly higher in diabetes mellitus group than control group （ P 〈 0.05）. The fasting plasma glucose （FPG） , 2 h postprandial plasma glucose （2 h PPG） , AUCg and HOMA IR were significantly higher in the diabetic patients with increased secretion of cortisol than those with normal secretion （ P 〈 0.05）. Exclusion of the influence from gender, age, body mass index and waist circumference, FPG, 2 h PPG, AUCg, ISI and HOMA IR were correlated with plasma and urinary cortisol. Conclusion Patients with diabetes mellitus have a significantly high prevalence of increased cortisol secretion, and the elevation of glucose is related with the increased secretion of cortisol.