血促肾上腺皮质激素、皮质醇水平及其节律与糖尿病肾病关系的研究

Relationship among cortisol, adrenocorticotropic hormone levels and their rhythms and diabetic kidney disease

目的:探讨血促肾上腺皮质激素(ACTH)、皮质醇水平及其节律与糖尿病肾病(DKD)的关系。方法:采用回顾性研究的方法,选取2010年8月至2019年8月在南京大学医学院附属鼓楼医院内分泌科住院的2型糖尿病(T2DM)患者1080例。收集患者性别、年龄、血压、体重指数(BMI)、糖尿病病程等一般资料。测定患者8:00、16:00、24:00血ACTH、皮质醇水平,并利用三角函数模型计算出振幅、相位。测定尿微量白蛋白/肌酐比值(UACR),基于性别、年龄及血肌酐水平计算估算的肾小球滤过率(eGFR)。根据UACR和eGFR将患者分为DKD组(360例)和非DKD组(720例);根据UACR水平将患者分为无白蛋白尿组(736例)、微量白蛋白尿组(260例)和大量白蛋白尿组(84例)。组间差异的比较采用独立样本t检验、Mann-Whitney U检验和单因素方差分析。采用二元logistic回归分析法探究血ACTH、皮质醇水平及其节律与DKD的关系。结果:DKD组8:00、16:00、24:00的血ACTH、皮质醇水平均显著高于非DKD组(P<0.05)。DKD组血ACTH、皮质醇的振幅显著高于非DKD组(P<0.05)。无白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组间8:00、16:00、24:00血ACTH、皮质醇水平及其振幅差异均有统计学意义(P<0.05)。与微量白蛋白尿组相比,大量白蛋白尿组血皮质醇相位延迟,差异具有统计学意义(P<0.05)。logistic回归分析结果显示,随着血ACTH及皮质醇水平升高,DKD的发生风险显著增加(均P<0.05),在校正年龄、性别、BMI后,DKD的发生风险仍然存在(均P<0.05)。结论:血皮质醇、ACTH水平增高及节律改变与T2DM患者DKD发生发展相关。

Objective To assess the effects of cortisol,adrenocorticotropic hormone(ACTH)and their rhythms on diabetes kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM).Methods This was a retrospective study.A total of 1080 patients with T2DM who were hospitalized in the Department of Endocrinology,Drum Tower Hospital Affiliated to Nanjing University School of Medicine from August 2010 to August 2019 were recruited,their general data such as gender,age,blood pressure,body mass index(BMI),and course of diabetes were collected.Cortisol and ACTH levels at 8:00,16:00,24:00 were measured,and use the trigonometric function model to calculate their amplitude and phase.Urine microalbumin/creatinine ratio(UACR)was measured,estimated glomerular filtration rate(eGFR)was calculated using the Chronic Kidney Disease-Epidemiology Collaboration formula based on gender,age and serum creatinine;patients were divided into DKD group(360 cases)and non-DKD group(720 cases)based on UACR and eGFR.According to UACR,patients were divided into no albuminuria group(736 cases),microalbuminuria group(260 cases)and large albuminuria group(84 cases).Differences between groups were compared using independent sample t test,Mann-Whitney U test and one-way analysis of variance.Binary logistic regression analysis was used to explore the relationship among blood ACTH,cortisol levels and their rhythms and DKD.Results ACTH and serum cortisol levels of the DKD group at 8:00,16:00,and 24:00 were significantly higher than those of the non-DKD group(P<0.05).The amplitude of ACTH and cortisol in the DKD group was significantly higher than that in the non-DKD group(P<0.05).The blood ACTH and cortisol levels at 8:00,16:00,24:00 and their amplitudes were statistically significant(P<0.05)among the no-albuminuria group,microalbuminuria group and macroalbuminuria group.Compared with the microalbuminuria group,the blood cortisol phase of the macroalbuminuria group was delayed,and the difference was statistically significant(P<0.05).The logistic regression analysis showed that with the increase of blood ACTH and cortisol levels,the risk of DKD increased significantly(all P<0.05).After adjusting for age,gender,and BMI,the risk of DKD still exists(all P<0.05).Conclusion Increased ACTH and serum cortisol levels and changes in their rhythm are related to the development of DKD in patients with T2DM.