HPA、HPT轴在焦虑障碍合并糖尿病中的作用研究

Role of HPA and HPT Axis in Anxiety Disorder Complicated with Diabetes Mellitus

目的探讨下丘脑-垂体-肾上腺轴(HPA轴)、下丘脑-垂体-甲状腺轴(HPT轴)在焦虑障碍合并糖尿病中的可能中介作用。方法选取562例住院焦虑障碍患者作为研究对象。测量其促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总四碘甲状腺原氨酸(TT4)、游离四碘甲状腺原氨酸(FT4)、促肾上腺皮质激素(ACTH)、皮质醇(PTC)等神经内分泌指标,同时进行口服葡萄糖糖耐量实验(oral glucose tolerance test,OGTT)。计算胰岛素抵抗指数(HOMA IR)、胰岛素敏感指数(WBISI)。结果焦虑障碍共病糖尿病患者83例(14.8%)。在<40岁人群中,FT4、HPT轴异常与焦虑障碍患者糖尿病患病率有关(P<0.05)。年龄(OR=1.067,95%CI:1.041~1.094,P=0.000)、FT4(OR=1.104,95%CI:1.022~1.193,P=0.012)、PTC(OR=1.001,95%CI:1.000~1.003,P=0.025)是焦虑障碍伴发糖尿病的影响因素。当PTC、HPA轴异常时,HOMA IR增高、WBISI降低(P<0.05);当ACTH、HPT轴、FT4、TT3异常时WBISI降低(P<0.05)。结论 HPA或HPT轴的异常可能是焦虑障碍伴发糖尿病的中介机制,早期关注并干预神经内分泌异常可能有助于防范焦虑障碍患者糖尿病的发生。

Objective To determine the mediating role of hypothalamic-pituitary-adrenal axis （HPA） and hypothalamic-pituitary-thyroid axis （HPT） axis in anxiety disorder in patients with diabetes mellitus. Methods A total of 562 hospitalized patients with anxiety disorder participate in the study. Serum thyroid-stimulating hormone （TSH）, total triiodothyronine （TT3）, free triiodothyronine （FT3）, total tetraiodothyronine （TT4）, free tetraiodothyronine （FT4）, adrenocorticotropic hormone （ACTH） and cortisol （PTC） were measured. Glucose tolerance test （OGTT） was performed, estimating insulin resistance index （HOMA IR） and insulin sensitivity index （WBISI）. Results Of the participants, 83 （14.8%） had diabetes. In those who were younger than 40 yr., the diabetic patients were more likely to have abnormal FT4 and HPT （ P〈0.05）. The patients with diabetes were more likely to be older （OR=1.067,95%CI：1.041-1.094, P=0.000） and have higher FT4 （OR=1.104,95%CI：1.022-1.193, P=0.012） and PTC （OR=1.001,95%CI：1.000-1.003, P=0.025）. Insulin resistance index increased while insulin sensitivity index decreased （ P〈0.05） with abnormal PTC and HPA axis. Insulin sensitivity index decreased （ P〈0.05） when ACTH, HPT axis, FT4 and TT3 were abnormal. Conclusion Abnormal HPA or HPT axis mediates diabetic complications in patients with anxiety disorder. Early interventions on neuroendocrine hormone abnormality may help prevent diabetes in patients with anxiety disorder.