2型糖尿病患者血清皮质醇与慢性并发症的关系

Correlation between serum cortisol and chronic complications in patients with type 2 diabetes mellitus

目的分析2型糖尿病患者血清皮质醇水平的变化情况,探讨糖尿病患者慢性并发症的发生与其体内血清皮质醇水平的关系。方法收集190例患者的一般资料和临床信息,其中2型糖尿病患者139例、非糖尿病患者51例,比较2组皮质醇分泌水平的差异;通过多因素Logistic回归分析了解糖尿病患者体内皮质醇水平升高与其慢性并发症的相关性。结果与非糖尿病患者相比,2型糖尿病患者8时、16时、0时血清皮质醇及24 h尿皮质醇均升高(P均<0.05)。发生慢性并发症的糖尿病患者的午夜皮质醇水平高于未发生者(P<0.05)。胰岛素抵抗指数高、男性、病程5~10年及病程超过10年以上、GHbA1c是糖尿病患者发生慢性并发症的危险因素(OR分别为2.671、2.696、3.313、10.523、1.291,P均<0.05)。结论糖尿病患者存在下丘脑-垂体-肾上腺轴功能异常,出现慢性并发症的糖尿病患者的午夜皮质醇水平明显高于未出现慢性并发症的患者,午夜皮质醇水平升高可能与慢性并发症相关。胰岛素抵抗程度高、男性及病程长是糖尿病患者出现并发症的危险因素。

Objective To investigate the changes of serum cortisol levels in patients with type 2 diabetes mellitus(T2DM),and analyze the correlation between the occurrence of chronic complications and serum cortisol levels.Methods Baseline and clinical data of 190 patients were collected,including 139 T2DM patients and 51 non-T2DM patients.The cortisol secretion level was statistically compared between two groups.The correlation between the elevated cortisol level and the incidence of chronic complications in T2DM patients was analyzed by multivariate Logistic regression model.Results Compared with the nonT2DM counterparts,the serum cortisol levels at 8 am.,16 pm.,and 0 am.,and 24 h urine cortisol level were significantly increased in T2DM patients(all P<0.05).Compared with T2DM patients without chronic complications,T2DM patients with chronic complications showed significantly higher midnight cortisol levels(P<0.05).High insulin resistance index,male,5-10 years of course of disease and>10 years of course of disease,GHbA1 c were the risk factors of chronic complications in T2DM patients(OR=2.671,2.696,3.313,10.523,1.291,all P<0.05).Conclusions T2DM patients present with abnormal HPA axis function.Midnight cortisol level in T2DM patients with chronic complications is significantly higher than that in their counterparts without chronic complications.The elevated midnight cortisol level is possibly associated with the incidence of chronic complications.High insulin resistance index,male and long course of disease are the risk factors of chronic complications in T2DM patients.