青少年1型糖尿病伴阳性抑郁症状患者血清皮质醇变化特点

Changes in fasting serum cortisol levels in adolescents with type 1 diabetes and elevated depressive symptoms

目的了解青少年1型糖尿病(T1DM)伴阳性抑郁症状患者的血清皮质醇变化特点。方法对28例青少年T1DM患者和31例健康同龄人采用流调中心用抑郁自评量表筛查阳性抑郁症状者,分为T1DM伴阳性抑郁症状组(15例)、单纯T1DM组(13例)、单纯阳性抑郁症状组(15例)和正常对照组(16例)。比较各组清晨空腹血清皮质醇水平,并运用Pearson相关分析法分析T1DM患者血清皮质醇和糖化血红蛋白(Hb A1c)与抑郁症状得分的相关性。结果与31例健康同龄人相比,28例T1DM患者平均清晨空腹血清皮质醇水平明显升高(P<0.01)。与单纯阳性抑郁症状组和正常对照组比较,T1DM伴阳性抑郁症状组患者清晨空腹血清皮质醇水平均明显升高(P<0.01)。T1DM患者血清Hb A1c值与其抑郁症状得分呈正相关(r=0.481,P=0.010)。结论青少年T1DM伴阳性抑郁症状患者清晨空腹血清皮质醇水平明显升高,提示两者共病患者的肾上腺皮质激素释放激素-促肾上腺皮质激素-皮质醇轴功能受损。青少年T1DM患者阳性抑郁症状的发生与糖代谢控制不良有关。

Objective To study the changes in serum cortisol levels in adolescents with type 1 diabetes（T1DM） and elevated depressive symptoms. Methods Twenty-eight adolescents with T1 DM and 31 healthy peers were assessed for depressive symptoms using a depression self-rating scale developed by the Epidemiological Survey Center. Selected subjects were classified into four groups： T1 DM with elevated depressive symptoms group（n=15）, T1 DM without elevated depressive symptoms group（n=13）, elevated depressive symptoms without T1 DM group（n=15）, and normal control group（n=16）. Fasting blood samples were collected in the morning, and the levels of serum cortisol were compared among the four groups. The correlations of serum levels of cortisol and glycosylated hemoglobin A1c（Hb A1c） with the score of depression self-rating scale were evaluated by Pearson correlation analysis. Results The fasting serum cortisol levels in the 28 T1 DM patients were significantly higher than in the 31 healthy peers（P〈0.01）. The fasting cortisol levels in the T1 DM with elevated depressive symptoms group were significantly higher compared with those in the elevated depressive symptoms without T1 DM group and normal control group（P〈0.01）. In adolescents with T1 DM, serum Hb A1 c level was positively correlated with the score of depression self-rating scale（r=0.481, P=0.010）. Conclusions The fasting serum cortisol levels in adolescents with T1 DM and elevated depressive symptoms are significantly increased, suggesting that the patients with comorbidity of T1 DM and depression develop dysfunction of the corticotropin-releasing hormone-adrenocorticotropic hormone-cortisol axis. The elevated depressive symptoms may be associated with a poor control of glucose metabolism.