2型糖尿病患者糖皮质激素变化的临床研究

Study on variations of glucocorticoids in patients with type 2 diabetes mellitus

目的 探讨 2型糖尿病患者糖皮质激素分泌变化的规律及其临床意义。方法 测定 2 2名健康人 (对照组 )和 6 3例 2型糖尿病患者 (其中 39例 2型糖尿病无微血管病变、2 4例 2型糖尿病并微血管病变 )的血皮质醇 (F) ( 8Am、4Pm )、2 4h尿游离皮质醇 (UFC)及血糖 (FBG、2hPG)、HbA1c、TC和TG。结果 2型糖尿病组的血F( 8Am、4Pm)及 2 4hUFC与对照组比较 ,差异有显著性 (P <0 .0 5 )。糖尿病有微血管病变组的 2 4hUFC的排量高于无微血管病变组 (P <0 .0 5 )。糖尿病组 2 4hUFC与HbA1c呈正相关 (r =0 .2 76 ,P <0 .0 5 ) ,与病程呈正相关 (r =0 .72 4,P <0 .0 1) ,与 2 4h尿微量白蛋白 (UAP)呈正相关 (r =0 .486 ,P <0 .0 1) ,与TG呈正相关 (r= 0 .42 1,P <0 .0 1)。结论 2型糖尿病患者糖皮质激素水平增高 ,加重了糖代谢和脂代谢紊乱 ,使糖尿病患者的病情恶化 ,最终促使糖尿病并发症的发生。

Objective To investigate the variation of glucocorticoids in patients with type 2 diabetes mellitus and to evaluate its clinic significance. Methods Blood samples of 22 cases of htealthy subjects(control group),63 cases of type 2 diabetes mellitus(including 39 patients without complication ,24 patients with diabetic microanglopathy)were tested for plasma cortisol levels(8a.m,4p.m)?24 h urinary free cortisol (UFC)?BS(FBG?2hPG)?HbA1c?TC?TG. Results Plasma cortisol levels and 24 hUFC in patients with type 2 diabetes mellitus were significantly higher than those in control group( P <0.05),24 hUFC outputs in diabetic microangiopathy group were significantly higher than those in diabetic noncomplication group ( P <0.05). 24 hUFC in diabetes mellitus was positive correlated with HbA1c( r =0.276, P <0.05),duration( r =0.724, P <0.01),UAP( r =0.486, P <0.01) and TG( r =0.421, P <0.01).Conclusion The elevation of glucocorticoids in patients type 2 diabetes mellitus exacerbated disorders of glucose and lipid metabolism?resulted in deterioration of disease and diabetic complications.