不同病程2型糖尿病合并抑郁症患者下丘脑-垂体-肾上腺轴激素水平分析

Analysis of hypothalamic-pituitary-adrenal axis function in type 2 diabetes mellitus patients combined with depression with different courses

目的 分析不同病程2型糖尿病（T2DM）合并抑郁症患者下丘脑-垂体-肾上腺轴功能.方法 将40例T2DM非抑郁症患者（糖尿病非抑郁症组）及42例T2DM合并抑郁症患者（糖尿病合并抑郁症组）分别按病程分为：病程＜5年、病程5～15年、病程＞15年;以体检的健康人群30例作为对照组.测定受试对象晨8：00时血浆促肾上腺皮质激素（ACTH）、皮质醇（Cor）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）及24h尿游离皮质醇（UFC）水平.结果 糖尿病非抑郁症组血浆ACTH及24 h UFC水平较对照组升高[（241.7±132.6） pg/L比（174.1±108.2） pg/L和（96.67±15.92） μg比（76.04±24.60）μg],差异有统计学意义（P＜0.05或＜0.01）;糖尿病非抑郁症组中病程＜5年、病程5～15年、病程＞15年患者血浆ACTH、Cor、24 h UFC水平比较差异均无统计学意义（P＞0.05）.糖尿病合并抑郁症组血浆Cor及24h UFC水平高于糖尿病非抑郁症组及对照组,差异有统计学意义（P＜0.01）,但与糖尿病非抑郁症组相同病程比较,仅ACTH在病程＜5年中差异有统计学意义（P＜0.01）,Cor及24 h UFC仅在病程＞15年中差异有统计学意义（P＜0.01）.糖尿病合并抑郁症组中病程＜5年血浆ACTH水平与病程5～15年、病程＞15年比较差异有统计学意义（P＜0.01）,Cor在不同病程间比较差异无统计学意义（P＞0.05）,24 h UFC在病程＞15年与病程＜5年、病程5～ 15年比较差异有统计学意义（P＜ 0.01或＜0.05）.糖尿病非抑郁症组Cor与FPG水平呈正相关（P＜ 0.01）,ACTH水平与FPG水平呈正相关（P＜0.05）.糖尿病合并抑郁症组Cor与FPG、HbA1c水平呈正相关（P＜0.01）,ACTH水平与各因素均无相关性（P＞0.05）,24 h UFC与FPG、HbA1c呈正相关（P＜0.01）.结论 T2DM合并抑郁症患者,随糖尿病病程延长,其下丘脑-垂体-肾上腺轴激素分泌紊乱加重.

Objective To analyze the hypothalamic-pituitary-adrenal axis function in type 2 diabetes mellitus（T2DM） patients combined with depression with different courses.Methods Forty T2DM without depression patients （T2DM without depression group） and 42 T2DM combined with depression patients （T2DM combined with depression group） were divided into 3 groups according to the courses：〈 5years,5-15 years,〉 15 years.Thirty healthy person were selected as control group.The levels of serum adrenocorticotropic hormone （ACTH）,cortisol （Cor）,fasting blood glucose （FPG）,glycosylated hemoglobin （HbA1c）,24 h urinary-free cortisol （UFC） were determined at 8：00 Am.Results The levels of serum ACTH,24 h UFC in T2DM without depression group were higher than those in control group [（241.7 ±132.6） pg/L vs.（174.1 ± 108.2） pg/L and （96.67 ± 15.92） μg vs.（76.04 ±24.60） μg],and there were significant differences （P 〈 0.05 or 〈 0.01）.There were no significant differences in the levels of serum ACTH,Cor,24 h UFC among 〈 5 years,5-15 years,〉 15 years in T2DM without depression group （P〉0.05）.The levels of serum Cor,24 h UFC in T2DM combined with depression group were higher than those in T2DM without depression group and control group,and there were significant differences （P 〈 0.01）,but compared with those in T2DM without depression group with the same courses,only ACTH was different in 〈5 years （P 〈 0.01）,Cor,24 h UFC was different in 〉 15 years （P 〈 0.01）.There was significant difference in the level of serum ACTH between 〈 5 years and 5-15 years,〉 15 years in T2DM combined with depression group （P 〈 0.01）,Cor had no difference among different courses （P 〉 0.05）,24 h UFC had difference between 〉 15 years and 〈 5 years,5-15 years （P〈 0.01 or 〈 0.05）.In T2DM without depression group,the level of serum Cor was positively correlated with FPG （P 〈 0.01）,the level of serum ACTH was positively correlated with FPG （P 〈0.05）.In T2DM combined with depression group,the level of serum Cor was positively correlated with FPG,HbA1c （P 〈 0.01）,the level of serum ACTH was no relationship with others,the level of serum 24 h UFC was positively correlated with FPG,HbA1c （P〈 0.01）.Conclusion With the prolonged courses of diabetes,the function of hypothalamic-pituitary-adrenal axis gets worse in T2DM patients combined with depression.