绝经后2型糖尿病妇女的下丘脑-垂体-肾上腺轴功能改变与腹型肥胖的关系

目的 探讨绝经后2型糖尿病、肥胖妇女下丘脑-垂体-肾上腺(HPA)轴的功能.方法 比较正常对照组(C组)、糖尿病非肥胖组(DM组)和糖尿病腹型肥胖组(DM+OB组)的一般临床特征、血尿皮质醇及促肾上腺皮质激素(ACTH)的浓度;通过0.25 mg地塞米松抑制试验和口服醋酸可的松试验,观察HPA轴功能的改变.结果 (1)基础状态下,C组、DM组和DM+OB组的血尿皮质醇和ACTH浓度没有差异,但地塞米松抑制试验示DM+OB组血皮质醇显著高于C组(P<0.01),提示糖皮质激素(GC)的负反馈作用受损.(2)口服醋酸可的松试验示肝可的松的转换率DM+OB组、DM组、C组依次降低,其中DM+OB组和C组差别具有统计学意义(P<0.05).(3)垂体前叶激素ACTH、LH、FSH和TSH水平DM+OB组、DM组、C组依次降低,其中DM+OB组LH和FSH水平较C组显著下降(P<0.01).结论 绝经后糖尿病肥胖患者皮质醇的负反馈调节机制受损,并伴有肝11β-羟类固醇脱氢酶1(11β-HSD-1)活性下降.

Hypothalamic-pituitary-adrenal axis in postmenopausal women with type 2 diabetes mellitus and visceral obesity

Objective To investigate the function of the hypothalamic-pituitary-adrenal (HPA) axis in postmenopausal women with type 2 diabetes and visceral obesity. Methods Subjects were divided into three groups:control group(group C),type 2 diabetes mellitus with non-obesity group (group DM) and type 2 diabetes mellitus with visceral obesity group (group DM + OB). General clinical characteristics, morning blood cortisol concentrations and 24 h urine free cortisol of three groups were compared. Serum cortisol levels were also compared after 0.25 mg dexamethasone suppression test and followed by oral intake of 25 mg cortisone acetate. Results (1) There were no significant differences in basal cortisol levels, but after inhibition with dexamethasone the group DM + OB showed significantly higher cortisol level than that in the control group (P < 0.01). (2) Conversion of oral cortisone to plasma cortisol differed significantly between the group C (lower) and group DM + OB (P < 0.05). (3) Plasma LH and FSH concerntrations were significantly lower in group DM + OB compared with group C (P < 0.01). Conclusion In the postmenopausal women with type 2 diabetes mellitus, the negative feedback mechanism and hepatic 11β-HSD-1 activity were impaired, especially in those with visceral obesity.