糖尿病患者高血糖与皮质醇分泌状况的关系

目的研究糖尿病患者的皮质醇分泌状况,探讨其与高血糖之间的关系。方法139例糖尿病患者(糖尿病组)行口服糖耐量试验(OGTT),计算胰岛素敏感指数(ISI)、HOMA指数(HOMAIR)、葡萄糖及胰岛素曲线下面积(AUCg,AUCi);同时检测患者血、尿皮质醇,以及血促肾上腺皮质激素(ACTH)等分泌情况。以52例非糖尿病健康者作为对照(对照组)。结果糖尿病组中高皮质醇分泌患者所占比例显著高于对照组(25.2%vs11.5%)(P<0.05)。糖尿病组08:00血皮质醇、16:00血皮质醇、日平均血皮质醇及尿游离皮质醇检测值均显著高于对照组(P<0.05)。糖尿病组中,伴高皮质醇分泌患者的空腹血糖(FPG)、糖负荷2h后血糖(2hPPG)、AUCg及HOMAIR均明显高于皮质醇正常分泌患者(P<0.05)。剔除性别、年龄、体质量指数及腰围的影响,FPG、2hPPG、AUCg、ISI及HOMAIR等与血、尿皮质醇水平相关。结论糖尿病患者高皮质醇分泌的患病率升高,其血糖升高与高皮质醇分泌互为因果。

Relationship between secretion of cortisol and higher blood glucose in patients with diabetes mellitus

Objective To observe the secretion of cortisol in patients with diabetes mellitus, and investigate its relationship with higher blood glucose. Methods One hundred and thirty-nine patients with diabetes mellitus (diabetes mellitus group) were performed oral glucose tolerance test (OGTT), and insulin index (ISI), HOMA IR, area under the curve of glucose (AUCg) and insulin (AUCi) were calculated. All of the patients were measured plasma cortisol, urinary cortisol and plasma adrenocorticotropic hormone (ACTH). Fifty-two healthy individuals without diabetes mellitus were served as control group. Results The prevalence of increased secretion of cortisol was significantly higher in diabetes mellitus group than control group(25.2% vs 11.5%, P<0.05). The plasma cortisol of 08:00 and 16:00 time point, daily average cortisol and urinary free cortisol were significantly higher in diabetes mellitus group than control group(P<0.05). The fasting plasma glucose (FPG), 2 h postprandial plasma glucose (2 h PPG), AUCg and HOMA IR were significantly higher in the diabetic patients with increased secretion of cortisol than those with normal secretion(P<0.05). Exclusion of the influence from gender, age, body mass index and waist circumference, FPG, 2 h PPG, AUCg, ISI and HOMA IR were correlated with plasma and urinary cortisol. Conclusion Patients with diabetes mellitus have a significantly high prevalence of increased cortisol secretion, and the elevation of glucose is related with the increased secretion of cortisol.