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2型糖尿病患者生物心理因素的研究
引用本文:孙学礼,刘涛生,唐莉,方向明,叶海燕,王珩,杨昆.2型糖尿病患者生物心理因素的研究[J].中华精神科杂志,2004,37(4):215-219.
作者姓名:孙学礼  刘涛生  唐莉  方向明  叶海燕  王珩  杨昆
作者单位:1. 610041,成都,四川大学华西医院心理卫生中心
2. 德阳市人民医院内科
3. 绵阳市中心医院内科
4. 自贡市第一人民医院内科
5. 绵阳市第三人民医院心身疾病科
基金项目:四川省卫生厅科学研究基金资助项目(020062)
摘    要:目的探讨2型糖尿病患者有关的生物心理因素。方法对90例2型糖尿病患者和30名正常人进行明尼苏达多相人格调查表(MMPI)、多伦多述情障碍量表(TAS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、社会支持量表(SS)等评定,测定血浆促肾上腺皮质激素(ACTH)、血小板5-羟色胺(5-HT)、血清白介素(IL)6(IL-6)及SIL-2R水平,并检测患者空腹血糖(FBG)、早餐后2h血糖(2PBG)和糖化血红蛋白指数(HbA1c)水平。将患者随机分为常规治疗组(常规组,45例;采用格列吡嗪7.5-15 mg/d)和常规治疗加帕罗西汀治疗组(合用帕罗西汀组,45例;采用格列吡嗪7.5~15 mg/d和帕罗西汀20 mg/d),治疗2个月后(两组分别失访4例和9例)观察患者上述量表评分、实验室指标的变化及其与FBG、2PBG、HbA1c等指标变化的关系。结果(1)治疗前,与正常对照组比较,患者组TAS、HAMD、HAMA总分高,SS总分较低(P<0.05),MMPI提示人格偏移;血浆ACTH、血清IL-6、SIL-2R及FBG浓度高,血小板5-HT浓度低(均P<0.01和<0.05)。(2)治疗后,合用帕罗西汀组的HAMD分、HAMA分、ACTH、IL-6以及糖代谢指标的改善程度均优于常规组。(3)患者组的HAMD减分率与ACTH变化率(r=0.37)及IL-6变化率(r=0.40)均呈正相关,HAMA减分率与ACTH变化率(r=0.41)呈正相关(均P<0.01);FBG下降率与H

关 键 词:患者  ACTH  HAMA  HAMD  2型糖尿病  常规治疗  帕罗西汀  分率  生物  心理因素
修稿时间:2003年8月18日

A study of psychosocial and biological mediate mechanism in type 2 diabetes mellitus
SUN Xue-li,LIU Tao-sheng,TANG Li,et al..A study of psychosocial and biological mediate mechanism in type 2 diabetes mellitus[J].Chinese Journal of Psychiatry,2004,37(4):215-219.
Authors:SUN Xue-li  LIU Tao-sheng  TANG Li  
Institution:SUN Xue-li,LIU Tao-sheng,TANG Li,et al. Mental Health Center,West China Hospital,Sichuan University,Chengdu 610041,China
Abstract:Objective The preliminary study was to explore the psychosocial factor and biological mediate mechanism in type 2 diabetes mellitus patients. Methods The subjects were 90 patients with type 2 diabetes mellitus and 30 normal controls, and the patients were randomly divided into two groups, with one being treated with glipizide 7. 5-15 mg daily and the other treated with glipizide 7. 5-15 mg daily in combination with paroxetine 20 mg daily for 2 months. The patients were assessed with the Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Scale ( HAMA), and so on. The plasma adrenocorticotrophic hormone (ACTH) , serum interleukin (IL)-6,SIL-2R and platelet 5-hydroxytryptamine (5-HT), fasting blood glucose ( FBG) , blood glucose 2 hour after breakfast (2PBC) and glycosylated forms of hemoglobin that can be separated from the main hemoglobin fractions haemoglobin A1c ( HbA1c.) were detected before and after treatment Results (1) The characteristics of personality and emotional expression in patients with diabetes mellitus were abnormal. (2) The scores of HAMD, HAMA, and the plasma ACTH, IL-6 in patients were significantly higher than that in normal controls, while 5-HT level in patients was significantly lower. (3) After treatment, the improvements on HAMD and HAMA scores and plasma ACTH, IL-6, and SIL-2R were better in patients receiving combination therapy than in patients with glipizide treatment only. Conclusions The personality characteristics and style of emotional express may be abnormal in patients with type 2 diabetes mellitus. The negative mood as anxiety and depression, changes ofneuroendocrine and immunization variables may be correlated to glucose metabolism. The medication of paroxetine combined with the routine therapy for type 2 diabetes mellitus may probably be helpful in improving the patients' mood, immunization, endocrine and the glucose metabolism.
Keywords:abetes mellitus  Interleukins  Neuroendocrinology  Neurotransmitters  Blood glucose  Paroxetine
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