糖尿病与下丘脑-垂体-肾上腺轴功能关系的系统评价  

Relationship between diabetes mellitus and hypothalamic-pituitary-adrenal axis： A systematic review

作　　者：韩立[1] 潘瑜[2] 何茳萍[1] 柳新燕[3] 李园园[1] 陈凤玲[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院内分泌科,201999 [2]上海交通大学医学院附属第九人民医院肾内科,201999 [3]上海交通大学医学院附属瑞金医院(古北)心血管科

出　　处：《中华内分泌代谢杂志》2016年第8期668-673,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金（81270908）

摘　　要：目的系统评价糖尿病与下丘脑．垂体．肾上腺（HPA）轴功能的关系，为临床筛查糖尿病患者HPA轴功能提供一定的客观依据。方法检索PubMed、Ovid、Embase、Web of Science文献数据库，筛选糖尿病与HPA轴功能关系的观察性研究。以标准化均数差（SMD）作为合并效应量，采用Stata12．0软件进行met0分析。结果Meta分析结果显示：与对照组相比，糖尿病组、T1DM组、T2DM组、糖尿病伴或不伴慢性并发症组及糖尿病合并高血压组血基础皮质醇水平均较高；糖尿病组地塞米松抑制后血皮质醇显著高于对照组：糖尿病组24hUFC、血ACTH水平较对照组均无显著差异。定性评价发现，糖尿病组与对照组之间清晨唾液皮质醇及皮质醇觉醒反应（CAR）各研究结果存在不一致，多数研究显示糖尿病患者存在CAR水平降低。结论糖尿病患者存在HPA轴功能异常，且存在合并症可能加重HPA轴功能异常。Objective To provide objective evidences for early screening of the hypothalamic-pituitary- adrenal （HPA） axis function in diabetic patients, the relationship between HPA axis function and diabetes mellitus was systematically reviewed. Methods PubMed, Ovid, Embase, Web of science Databases were retrieved from articles reporting the relationship between HPA axis function and diabetes mellitus. Meta-analysis were carried out by Stata 12.0 software for heterogeneity test and data merged among articles for the inclusion and exclusion criteria. Results Our meta-analysis showed the following results ： Compared with control group, the basal plasma cortisol level in total diabetes group, T1 DM group, T2DM group, diabetes patients （with or without chronic complications） combined with hypertension was significantly higher. Compared with control group, postdexamethasone cortisol level was markedly higher in diabetes group. There was no significant difference in 24 h urinary free cortisol （24h UFC） and ACTH levels between diabetes group and control group. Our qualitative evaluation shows the following results： the differences of awaking salivary cortisol and cortisol awakening response（CAR） between the two groups were inconsistent among all included studies. Most studies showed that CAR was lower in diabetic patients. Conclusion The present analysis has demonstrated that HPA axis dysfunction exists along with diabetes mellitus, and diabetic comorbidity may further worsen the HPA axis dysfunction.

关 键 词：糖尿病 下丘脑-垂体-肾上腺(HPA)轴 血皮质醇 24h尿皮质醇 皮质醇觉醒反应 (CAR) 

分 类 号：R587.1[医药卫生—内分泌]