2型糖尿病患者褪黑素水平与下丘脑-垂体-肾上腺轴激素关系的研究

目的 探讨不同血糖平均水平T2DM患者下丘脑-垂体-肾上腺（HPA）轴激素与褪黑素（MLT）的关系. 方法 将90例T2DM患者根据HbA1 c水平分为HbA1 c＜7％组28例、7％≤HbA1 c≤10％组32例和HbA1 c＞ 10％组30例,另选取健康对照（NC）组30名,分析不同HbA1c水平内源性MLT与HPA轴激素的关系. 结果 （1）HbA1c＜7％组和NC组HPA轴激素、MLT水平相对较低,而7％≤HbA1 c≤10％组和HbA1 c＞ 10％组相对较高.（2）多元相关分析显示,在HbA1 c＜7％组和NC组中,MLT与促肾上腺皮质激素（CRH）呈正相关（r=0.476、0.487,P均＜0.05）;在7％≤HbA1 c≤10％组和HbA1 c＞10％组MLT与血清皮质醇（CORS）呈正相关（r=0.318、0.047,P均＜0.05）.（3）多元逐步回归分析表明,T2DM患者血清CRH、促肾上腺皮质激素释放激素（ACTH）、CORS是MLT升高的独立影响因素. 结论 不同血糖水平的T2DM患者MLT与HPA轴的关系及作用机制不同.过高的CORS可刺激MLT分泌,HPA轴与MLT相互影响,协同作用影响糖尿病的发生发展.

Relationship between serum melatonin levels and the hormones of hypothalamic-pituitary-adrenal axis in patients with type 2 diabetes

Objective To investigate the relationship between the hormones of hypothalamicpituitary-adrenal（HPA） axis and melatonin （MLT） in T2DM patients with different level of blood glucose.Methods A total of 90 patients with type 2 diabetes were divided into HbA1c〈7% group,7% ≤HbA1c≤10% group and HbA1c〉10% group,and 30 healthy people were selected as control （NC） group.The relationship between endogenous MLT of different HbA1 c levels and hypothalamic-pituitaryadrenal （HPA） axis was analyzed.Results （1） The levels of hormones of HPA axis and MLT were lower in NC and HbA1c〈7% group.The levels of hormones of HPA axis and MLT were higher in 7%≤ HbA1 c≤10% and HbA1 c〉10% group than in NC group.（2） Multiple linear correlation analysis showed that Cortiootropin-releasing hormone（CRH） was a positive correlation with melatonin in NC and HbA1 c〈 7% group（r=0.476,0.487,all P〈0.05）;There was a positive correlation between MLT and serum cortisol in 7%≤HbA1c≤10% and HbA1c〉10% group（r=0.318,0.359,all P〈0.05）; （3） Multiple linear regression showed that CRH,ACTH,and cortisol were independently relative factors for MLT in T2DM patients.Conclusion The relationship and its mechanisms between HPA axis and MLT is various in T2DM patients with different blood glucose levels.The excessive secretion of cortisol may stimulate the excretion of MLT which interacts with the HPA axis and influence the development of diabetes synergistically.