胰岛素强化治疗对初诊Ⅱ型糖尿病患者下丘脑-垂体-肾上腺轴功能的影响

Effects of short-term intensive insulin therapy on hypothalamic-pituitayadrenal axis function in newly diagnosed type 2 diabetic patients

目的观察胰岛素强化治疗对初诊Ⅱ型糖尿病患者下丘脑-垂体-肾上腺(HPA)轴及相关生化指标的影响。方法对32例初诊Ⅱ型糖尿病患者进行10～14天的胰岛素强化治疗(4次皮下胰岛素注射)。比较治疗前后空腹血糖(FPG)、餐后2小时血糖(2hPG)、血甘油三酯(TG)、血胆固醇(TC)、空腹胰岛素(FINS)及8:00,16:00,24:00患者的血浆皮质醇、促肾上腺皮质激素(ACTH)水平和24h尿皮质醇水平。结果胰岛素强化治疗后,患者8:00,16:00,24:00血浆皮质醇及24小时尿皮质醇与治疗前相比,差异有统计学意义(P<0.05);各时段ACTH水平与治疗前相比,差异无统计学意义(P>0.05)。治疗后患者的FPG、2hPG、TG、TC及FINS水平与治疗前相比明显降低,差异有统计学意义(P<0.05)。结论胰岛素强化治疗能改善初诊糖尿病患者的糖、脂代谢及胰岛素分泌情况,降低血皮质醇水平,促进HPA轴恢复。

Objective To observe the effects of short-term intensive insulin therapy on hypothalamic-pituitary-ad- renal axis （HPAA） function and related metabolic parameters in newly diagnosed patients with type 2 diabetes mellitus. Methods 32 newly diagnosed T2DM patients were treated with continuous subcutaneous insulin infusion or multiple in- jections for about 2 weeks. The levels of plasma cortisol and adrenocorticotropic hormone （ACTH） at hour 8 and 16, 24h urinary total cotisol（UFC）, fasting plasma glucose （FPG）, 2h postprandial glucose （2hPG） were determined before and after therapy. Results After intensive insulin therrapy, levels of plasma corrtisol at hours 8, 16, 24 and 24 hUFC de- creased （P〈0.05）. FBG, 2hPG, TG and TC were significantly decreased after treatment as compared with the basal levels before treatment （P〈0. 05）. But no difference was noted in plasma ACTH at hours 8, 16, 24（P〉0. 05）. Conclu- sion Intensive insulin therapy can remarkably improve the functions of glucose and lipid metabolism, and insulin secre- tion, lower effectively the level of hematuria cortisol, and promote the recovery of HPAA function.