不同病程2型糖尿病患者皮质醇水平及其影响因素分析

Cortisol levels and its influcing factors in type 2 diabetic patients with different courses

目的 探讨2型糖尿病患者皮质醇（Cor）水平变化及其影响因素.方法 将98例2型糖尿病患者作为病例组,按病程分为3个亚组：病程＜5年组,病程5-15年组,病程≥15年组;以体检的健康人群98例作为正常对照组.测定受试对象的晨8时血促肾上腺皮质激素（ACTH）、血皮质醇（Cor）、24小时尿游离皮质醇（UFC）等.结果 （1）在2型糖尿病组血ACTH、Cor、UFC水平均高于正常对照组,差异有统计学意义（P＜0.01）;（2）2型糖尿病患者血ACTH、Cor、UFC平均水平随糖尿病病程的延长而升高,但在3个亚组间血ACTH、Cor比较差异无统计学意义,UFC于病程≥15年组与病程＜5年组间比较差异有统计学意义（P＜0.01）;（3）多元逐步回归分析显示2型糖尿病患者血ACTH与糖尿病慢性并发症数目呈正相关,与年龄呈负相关（P＜0.01）;Cor与慢性并发症数目、HbAlc呈正相关（P＜0.01）,与性别呈负相关（P＜0.05）;UFC与病程、WHR呈正相关、与性别呈负相关（P＜0.01）.结论 （1）2型糖尿病患者血ACTH、Cor、UFC水平较正常人群明显升高.（2）2型糖尿病患者皮质醇的分泌与糖尿病病程、慢性并发症数目、年龄、性别、腰臀比及糖代谢水平相关.

Objective To investigate the cortisol（Cor） levels and its influcing factors in type 2 diabetic patients. Methods According to the 1999 WHO diagnostic criteria of diabetes, 98 hospitalized patients were selected as experimental group ,who were divided into 3 groups according to the durations of the disease （ group A, 〈 5 years ; group B,5 - 15 years ; group C≥ 15years ） , and 98 cases of healthy people medical examined in the same period in our hospital as control group. Serum ACTH, Cor and UFC were measured. The data were analyzed by SPSS 17.0. Results （ 1 ） The ACTH, Cor and UFC levels in T2DM group were significantly higher than that in the eontrol group（ P 〈 0.01 ）. （2）In T2DM group, the serum ACTH, Cot and UFC levels were increased as the duration extended. However,among the 3 subgroups,the differences of serum ACTH and Cor were no statistical significance. The UFC level of group C was significantly higher than that in group A （ P 〈 0.01 ）. （ 3 ） In T2DM group, to ACTH, Cot, UFC as the dependent variable, the other general clinical features and metabolic markers for the independent variable, multiple regression analysis showed that ACTH and the number of chronic complications of diabetes were positively correlated, and a negative correlation with age, （ P 〈 0.01 ） ; Cor and the number of chronic complications, HbAlc were positively correlated（ P 〈 0.01 ）, and negatively correlated with gender（ P 〈 0.05 ） ;UFC and duration of the disease, WHR were positively correlated, and negatively correlated with gender （ P 〈 0.01 ）. Conclusions （1）The serum ACTH, Cor and UFC levels in type 2 diabetic patients were significantly higher than that in healthy people. （2）In type 2 diabetic patients, the secretion of cortisol was related to the duration of the disease ,the number of chronic complications, age, sex,WHR and glycometabolism.