2型糖尿病患者下丘脑-垂体-肾上腺皮质轴功能分析  

Analysis of hypothalamus-pituitary-adrenal cortex axis function in patients with type 2 diabetes mellitus

作　　者：丁晴晴 张磊[2] 高维国[2] 朱娅梅[2] 李梦阳 丁玉森 DING Qingqing;ZHANG Lei;GAO Weiguo(Weifang Medical University,Clinical Medical,Weifang 261000,China)

机构地区：[1]潍坊医学院临床医学院,261000 [2]青岛内分泌糖尿病医院

出　　处：《中国糖尿病杂志》2021年第12期911-915,共5页Chinese Journal of Diabetes

摘　　要：目的探讨T2DM患者下丘脑-垂体-肾上腺皮质(HPA)轴功能状态及其与代谢紊乱的关系。方法选取2017年1月至2019年4月于我院行HPA轴激素水平检查的住院T2DM患者2741例,男1487例,女1254例,评价促肾上腺皮质激素(ACTH)、皮质醇(COR)、24 h尿游离皮质醇(24 hUFC)水平。将行HPA轴昼夜节律检查的512例患者单独分组,分析HPA轴昼夜节律分布情况。按照是否应用Ins分为非Ins治疗组1107例和Ins治疗组1634例,评价应用Ins及不同临床及代谢指标对各激素分泌水平的影响。结果 T2DM患者COR水平低于正常值,其中男性早晨垂体-肾上腺皮质轴活性高(P<0.05)。ACTH、COR昼夜节律紊乱率分别为35.16%、22.46%。Ins治疗组HPA轴激素水平高于非Ins治疗组(P<0.05)。不同年龄、DM病程、FIns、HOMA-IR、HDL-C、hs-CRP组间COR水平差异显著(P<0.05)。结论 T2DM患者COR低于正常水平,年龄、DM病程、炎症及外源性胰岛素可能通过代偿机制促进COR分泌,胰岛β细胞胰岛素分泌能力及HDL-C可能通过负反馈调节基础COR分泌。Objective To investigate the functional status of the hypothalamus-pituitary-adrenal cortex(HPA)axis and its relationship with metabolic disorders in patients with type 2 diabetes mellitus(T2 DM).Methods A total of 2741 hospitalized patients with T2 DM who underwent HPA axis hormone level examination were enrolled in this study from in our hospital.Among them,1487 were male,and 1254 were female.Adrenocorticotropic hormone(ACTH),cortisol(COR),24-hour urinary free cortisol(24 h UFC)level were analyzed in all the patients.Patients underwent HPA axis circadian rhythm examination(512 cases)were selected to analyze the distribution of HPA axis circadian rhythm.Then the patients were further divided into non-application insulin(Ins)group(n=1107)and the Ins treatment group(n=1634)according to whether Ins treatment was applied.The effects of Ins and different clinical and metabolic indicators on hormone levels were analyzed.Results The COR level was mainlyin or below the normal level in T2 DM patients.Among them,men had a higher pituitary-adrenal cortex axis activity in the morning(P<0.05).The rates of hormone circadian rhythm disorders were 35.16% and 22.46% respectively.The HPA axis hormone levels were higher in the Ins group than in the non-Ins treatment group(P<0.05).There were significant differences in COR levels in groups with different age,durationof diabetes,fasting insulin(FIns),insulin resistance index(HOMA-IR),high-density cholesterol lipoprotein(HDL-C),and high-sensitivity C-reactive protein(hs-CRP)(P<0.05).Conclusion The cortisol level is lower than normalin T2 DM patients.Age,DM duration,inflammation and the use of exogenous Ins may promote the secretion of COR throughcompensatory mechanisms,and the basal Ins secretion capacity of β cells and HDL-C may regulate the secretion of basal COR through negative feedback.

关 键 词：糖尿病 2型 促肾上腺皮质激素 皮质醇 昼夜节律 

分 类 号：R587.1[医药卫生—内分泌]