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目的探讨高血糖患者皮质醇的分泌情况。方法对222例高血糖患者行75g OGTT,并计算ISI、稳态模型评估胰岛素抵抗指数(HOMA-IR)、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,血促肾上腺皮质激素(ACTH)等,将所得结果与65名非高血糖正常者(对照组)进行比较。结果 (1)高血糖患者中高皮质醇分泌者为20.3%(45/222),对照组为10.8%(7/65)。高血糖患者08:00[(335.7±90.7)vs(297.3±77.6)nmol/L]及16:00血皮质醇[(203.1±67.5)vs(177.7±48.4)nmol/L]、日平均血皮质醇[(208.9±62.2)vs(187.4±49.0)nmol/L)]及尿游离皮质醇[(77.9±39.1)vs(65.5±16.1)μg/24h)]均高于对照组。(2)伴高皮质醇分泌的糖尿病患者FPG[(10.8±3.7)vs(7.8±1.7)mmol/L]、2hPG[(18.7±5.3)vs(13.9±3.3)mmol/L]及血糖曲线下面积(AUCG)[(2980±860)vs(2287±433)]高于正常皮质醇分泌的糖尿病患者,ISI则低[(-4.8±0.8)vs(-4.2±0.9)];伴高皮质醇分泌的IGR患者AUCG高于正常皮质醇分泌的患者[(1742±155)vs(1585±153)]。(3)高血糖患者FPG、2hPG及AUCG等与血、尿皮质醇水平相关;多元逐步回归分析提示,FPG、2hPG及AUCG是影响08:00、16:00血皮质醇及夜间皮质醇占清晨分泌量百分比(F%)的独立相关因素。结论高血糖患者高皮质醇分泌的发生率升高,血糖升高与高皮质醇分泌相关。
Objective To investigate the secretion of cortisol in patients with hyperglycemia. Methods Twenty-two patients with hyperglycemia underwent 75 g OGTT, and ISI was calculated. The homeostasis model assessment index (HOMA-IR), area under the curve of glucose and insulin (AUCG, AUCI) Adrenocorticotropic hormone (ACTH), etc. The results obtained were compared with 65 non-hyperglycemic subjects (control group). Results (1) Hyperglycemia patients with high cortisol secretion of 20.3% (45/222), the control group was 10.8% (7/65). Patients with hyperglycemia at 08:00 [(335.7 ± 90.7) vs (297.3 ± 77.6) nmol / L] and 16:00 cortisol (203.1 ± 67.5 vs 177.7 ± 48.4 nmol / L, (208.9 ± 62.2 vs 187.4 ± 49.0 nmol / L) and urinary free cortisol (77.9 ± 39.1 vs 65.5 ± 16.1 μg / 24h) were higher than those in the control group. (2) FPG [(10.8 ± 3.7) vs (7.8 ± 1.7) mmol / L], 2hPG [(18.7 ± 5.3) vs (13.9 ± 3.3) mmol / L] and hyperglycemia (-4.8 ± 0.8) vs (-4.2 ± 0.9)] in patients with diabetes mellitus (AUCG) [(2980 ± 860) vs (2287 ± 433)] higher than those in normal cortisol; AUCG secretion in patients with IGR was higher than that in patients with normal cortisol secretion [(1742 ± 155) vs (1585 ± 153)]. (3) FPG, 2hPG and AUCG in patients with hyperglycemia were correlated with serum and urinary cortisol levels. Multiple stepwise regression analysis indicated that FPG, 2hPG and AUCG affected blood cortisol and nocturnal cortisol at 08: 00,16: 00 Secretion volume percentage (F%) of the independent relevant factors. Conclusions The incidence of hypercortisol secretion in patients with hyperglycemia is increased, and hyperglycemia is associated with the secretion of high cortisol.