血糖控制与渴感和抗利尿激素反应性关系

Effects of glycemic control on the secretion of antidiuretic hormone (ADH) and thirst perception in type 2 diabetes

目的 探讨血糖控制对 2型糖尿病病人渴感和抗利尿激素 (ADH)反应性的影响。方法 测定伴渴感减退及ADH分泌不足的 8例血糖控制不良 (Hb A1 c11 5 %～ 14 5 % )的 2型糖尿病病人 ,在血糖满意控制 (Hb A1 c5 9%～8 4 % ) 12个月前后血浆渗透压 (血渗 )正常 (2 75～ 2 85 m Osm kg H2 O)和增高 (3 10 m Osm kg H2 O)时渴感程度及血浆ADH水平 ,并进行自身前后比较。渴感程度采用视觉量表评估 ,ADH采用放免法测定。结果 血糖满意控制 12个月对血渗正常时渴感及血浆 ADH水平无明显影响。对血渗增高时渴感的影响不一 ,8例中有 5例渴感增强 (前∶后 ,4 5 0±0 5 8cm vs5 76± 0 77cm,P<0 0 0 1) ,3例渴感无明显变化 (前∶后 ,4 2 0± 0 92 cm vs4 4 7± 1 2 9cm,P>0 0 5 ) ;血渗增高时血浆 ADH8例均明显增高 (前∶后 ,5 63± 0 81ng L vs7 13± 0 5 9ng L,P <0 0 0 1)。结论 血糖满意控制 12个月可明显改善全部 8例 ADH及部分病例渴感对血浆高渗的反应。提示长期高血糖高血渗是致 ADH分泌不足及渴感减退的原因之一。

Objective To determine the effects of glycemic control on thirst and ADH response to plasma hyperosmolality in type 2 diabetes with thirst perception defect and low ADH reserve. Methods Eight poorly controlled type 2 diabetics (HbA 1c 12 56±1 05%, ranged from 11 5%～14 5%) with thirst perception defect and low ADH reserve were studied by intravenous infusion of 5% sodium chloride at the rate of 0 06ml·kg -1 /min before and twelve months after improving glycemic control. The levels of ADH of plasma and thirst scales were measured at the levels of normal and hyper osmolalities of plasma. The ADH level of plasma was determined by radioimmunoassay. Thirst intensity was estimated by means of a linear visual analogue scale.Results Significant improvement in glycemic control (before vs. after: mean HbA 1c 12 56±1 05% vs. 6 94±0 93%,P<0 001) was achieved without severe hypoglycemia during the twelve month period of treatment with oral antidiabetic drugs (glibenclamide or glipizide and metformin) and/or rapid acting insulin in eight cases of type 2 diabetes. There were no differences of thirst scales and plasma ADH levels at the level of normal osmolality of plasma (near 280 mOsm/kgH 2O, ranged from 275 mOsm/kgH 2O to 285 mOsm/kgH 2O) before and twelve months after improving glycemic control in eight patients. As compared with not improving glycemic control at the level of plasma hyperosmolality (310 mOsm/kgH 2O), after improving glycemic control, plasma ADH levels were significantly increased (before vs. after: 5 63±0 81ng/L vs.7 13±0 59ng/L,P<0 001). After improving glycemic control, thirsty scales of five out of eight patients were significantly increased at the level of plasma osmolality of 310 mOsm/kgH 2O (before vs. after: 4 50±0 58cm vs. 5 76±0 77cm,P<0 001), but thirsty scales of three out of eight patients showed no change (before vs. after: 4 47±1 29cm vs. 4 20±0 92cm,P>0 05).Conclusion Improving glycemic control increases ADH secretion and thirsty scales in poorly controlled type 2 diabetes patients with thirst perception defect and low ADH reserve.