糖皮质激素替代治疗对成人腺垂体功能减退症患者糖脂代谢的影响

目的:研究成人腺垂体功能减退症患者给予不同生理剂量的糖皮质激素替代治疗后2年对其血糖、血脂的影响。方法:收集广州医科大学附属第六医院2017年6月至2018年6月收治的及在门诊复诊的既往已明确诊断为成人腺垂体功能减退症患者18例,按用药剂量不同分为观察组和对照组,每组9例。观察组用氢化可的松20mg/d剂量治疗,对照组用30mg/d剂量治疗。对两组患者进行为期2年的随访,记录治疗前、治疗2年后患者的空腹血糖、糖化血红蛋白、血脂、肝肾功能、血钠、血钾等指标,并比较治疗效果。结果:腺垂体功能减退症不论采用氢化可的松20mg/d还是30mg/d生理替代剂量治疗,与患者血糖指标异常关系不大,甚至可降低血脂(三酰甘油)水平(P<0.05)。结论:对腺垂体功能减退症患者补充生理替代剂量的糖皮质激素是相对安全的,也是必要的,但仍需监测血糖、血脂变化情况,同时建议根据临床症状不同,采取个体化给药原则。

Correlation Study between Glucocorticoid Replacement Regimens in Hypopituitary Patients and Disorder of Glycolipid Metabolism

Objective:To investigate the effect of physiological dose of glucocorticoid replacement therapy on blood glucose and blood lipid in adult patients with adenohypophysis.Methods:From June 2017 to June 2018,a total of 18 patients with adult adenohypophysis who had been definitely diagnosed in the Department of endocrinology in the sixth affiliated hospital of guangzhou medical university and in the outpatient department were collected and divided into observation group and control group with 9 cases in each group.They were treated with hydrocortisone 20 mg/d and 30 mg/d respectively,and the two groups were followed up for 2 years.Blood glucose,glycosylated hemoglobin,blood lipid,liver and kidney function,blood sodium,blood potassium and other indicators were recorded before and 2 years after treatment,and the therapeutic effects were compared.Results:After treatment with physiological replacement dose of hydrocortisone,whether 20 mg/d or 30 mg/d,there was little relationship between hydrocortisone and abnormal blood glucose,and even the level of blood lipid(triglyceride)could be reduced after replacement treatment(P<0.05).Conclusion:It is relatively safe and necessary to supplement physiological replacement dose of glucocorticoid for patients with hypopituitarism,but it is still necessary to monitor the changes of blood glucose and blood lipid,and it is suggested to adopt the principle of individualized administration according to different clinical symptoms.