冠心病患者唾液皮质醇水平与糖代谢状况的研究

Relationship between salivary cortisol and glucose metabolism in patients with coronary heart disease

目的:探讨冠心病(CHD)患者唾液皮质醇水平与糖代谢状况的变化及影响因素。方法:选取正常对照组(NC组)35例,将CHD患者(CHD组)98例按OGTT结果分为3组,即单纯CHD组、CHD糖调节异常组(CHD+IGR组)和CHD伴糖尿病(DM)组(CHD+DM组),采用酶联免疫法测定8AM、4PM及0AM唾液皮质醇水平,比较CHD组与NC组及各亚组之间唾液皮质醇水平差异,进一步分析其相关因素。结果:①CHD患者唾液皮质醇水平(8AM,0AM)与NC组比较差异有统计学意义(P<0.05),唾液皮质醇(4PM)、超敏C反应蛋白2组间差异无统计学意义(P>0.05)。②CHD各亚组唾液皮质醇水平(8AM)差异有统计学意义,伴IGR或DM者高于单纯CHD组(P<0.05),伴DM者超敏C反应蛋白高于伴IGR或单纯CHD组(P<0.05),0AM、4PM唾液皮质醇水平3组间差异无统计学意义(P>0.05)。③相关分析显示CHD患者8AM唾液皮质醇水平与糖化血红蛋白、超敏C反应蛋白呈正相关(r=0.327,P<0.05;r=0.215,P<0.05),与空腹血糖无关。结论:下丘脑-垂体-肾上腺轴功能失调可能是CHD患者易于出现糖代谢异常的重要参与因素,CHD患者皮质醇节律异常,可能与炎症、免疫有关,亦可能为本病进展的标志之一。

Objective：To analyze the relationship between salivary cortisol and glucose metabolism in patiens with coronary heart disease and the factors that influence the level of cortisol.Method：98 CHD patients were recruited and divided into three groups：Simple CHD,CHD＋ Impaired glucose regulation（IGR） and CHD＋ diabetes mellitus（DM） according to OGTT results.The patients without CHD and DM were included as healthy control.The level of salivary cortisol（SC） was compared in these four groups.The levels of salivary cortisol,high sensitivity C reactive protein（hsCRP） and glycosylated hemoglobin（HbA1c） were measured by ELISA.SA was measured at different time point（8AM,0AM and 4PM）.Result：①The levels of SC in CHD group（8AM,0AM） were significantly higher than the control group,however the level of SA and hsCRP at the point of 4PM showed no significant difference between two groups.②The CHD＋IGR group and CHD＋DM group have significantly higher level of SC as compared to CHD group,The level of hsCRP in CHD＋DM group was significantly higher than that in CHD and CHD＋IGR groups.③There were positive correlations of SC level at point of 8 AM with HbA1c and with hsCRP,but no correlation was found between SC level at point of 8AM levels and fasting blood glucose.Conclusion：HPA dysfunction is an important factor in the development of glucose metablism in patients with cardiovascular disease.Abnormal circadian rhythms of cortisol is associated with immune-mediated inflammation and may be a marker of pathological processes of atheroscoerotic lesions.