褪黑素对糖尿病应激状态垂体-肾上腺轴功能的影响  

Effects of Exogenous Melatonin on Function of Pituitary-Adrenal Axis in Diabetics on Stress

作　　者：钟历勇[1] 张林[1] 金晖[1] 王惠[1] 杨志红[1] 董莉[1] 杨兵全[1] 李玲[1] 孙子林[1] 葛祖恺[1] 

机构地区：[1]东南大学附属中大医院,南京210009

出　　处：《内科急危重症杂志》2003年第3期150-153,共4页Journal of Critical Care In Internal Medicine

基　　金：江苏省科委社会发展基金资助项目 (No .BS980 35 )

摘　　要：目的 :探讨褪黑素对糖尿病应激状态垂体 肾上腺轴功能影响及改善糖代谢紊乱作用的神经内分泌机制。方法 :采用随机、单盲、安慰剂平行对照的方法 ,连续观察 3天外源性褪黑素及安慰剂对 37例糖尿病急性并发症患者垂体 肾上腺轴及糖尿病急性代谢紊乱相关指标的影响 ;并观察给药两周后患者糖代谢控制情况。结果 :①患者下丘脑 垂体 肾上腺 (HPA)轴处于激活状态 ,于药物干预前血浆ACTH和皮质醇水平均高于正常值 ,两组间血浆ACTH和皮质醇水平的差异无显著意义 (P >0 .0 5 ) ;②药物干预后第 1天两组间血浆ACTH和皮质醇水平均有所下降 ,但差异无显著意义 (P >0 .0 5 ) ;药物干预后第 2天和第 3天褪黑素组血浆ACTH和皮质醇下降程度均明显高于安慰剂组 ,两组间差异具显著意义 (P <0 .0 5 ) ;③药物预后 3d内褪黑素对血浆血糖、HCO3 -、阴离子间隙及血浆渗透压等糖尿病急性代谢紊乱相关指标无明显影响。给药两周后褪黑素组患者血浆空腹血糖、餐后血糖及果糖胺水平均较安慰剂组明显下降 ,两组间差异具显著意义 (P <0 .0 5 )。结论 :褪黑素对糖尿病应激状态垂体 肾上腺功能有一定抑制作用 ,适度的抑制糖尿病急性并发症患者HPA轴功能可能对糖代谢的控制及疾病预后转归有利。Objective: To investigate the effects of exogenous melatonin on function of pituitary adrenal axis and the neuroendocrinal mechanism for improving carbonhydrate metabolism in diabetic patients on stress. Methods: Effects of exogenous melatonin and placebo on pituitary adrenal axis and the parameters related to diabetic acute complications were observed in 37 diabetics with acute complications by means of random, single blinded and placebo parallel control for 3 consecutive days and then, the glucose metabolic parameters were observed two weeks after treatment. Results: ① Hypothalamus pituitary adrenal (HPA) axis of patients was in activated state, plasma levels of adrenocorticotropin hormone (ACTH) and cortisol were higher than normal physiologic level. But there was no significant difference between treatment and placebo group ( P >0.05). ② Both the plasma ACTH and cortisol levels were decreased in two groups at the first day after treatment, but there were no significant difference ( P >0.05); both the plasma ACTH and cortisol levels in melatonin treated group decreased significantly than the placebo control group ( P <0.05) on the 2nd and 3rd days;③There were no significant effect of exogenous melatonin on plasma glycaemia, HCO 3 -, anion gap and osmotic pressure,the related parameters in diabetics with acute complications during 3 days period in this study. There were significant differences in the glucose metabolic parameters, such as fasting plasma glucose,postprandial plasma glucose and fructose amine levels between melatonin treated and placebo control group respectively 2 weeks after treatment ( P <0.05). Conclusion: Exogenous melatonin inhibited HPA axis function which was activated by stress in the critically pathophysiologic status of diabetic patients, therefore, it is beneficial for both control of glucose metabolism and prognosis of diabetic patients by inhibited the activated HPA axis function moderately.

关 键 词：褪黑素 糖尿病 下丘脑-垂体-肾上腺轴 应激 

分 类 号：R587.1[医药卫生—内分泌]