【作者】 马兰；

【导师】 陈丽；

【作者基本信息】 山东大学 ， 内科学， 2008， 硕士

【摘要】 目的探讨2型糖尿病患者早期皮质醇、ACTH水平改变与胰岛素抵抗(IR)的关系,并进一步讨论非腹型肥胖病人与腹型肥胖病人垂体—肾上腺轴功能紊乱情况是否有所差异。方法将一定数量2型糖尿病患者(T2DM)分为腹型肥胖组和非腹型肥胖组进行体格检查,测定腰围(WC),臀围(HC),计算腰臀比(WHR)、体重指数(BMI),测定血清皮质醇及ACTH(8am、4pm)水平,空腹状态下血糖、血脂、糖化血红蛋白(GHbAlc)(8Am)以及空腹血清胰岛素(FINS)和血糖水平;按HOMA模型计算胰岛素抵抗指数:HOMA—IR=FINS×FBG/22.5,以此反映2型糖尿病患者IR的情况,并分析血清皮质醇、ACTH水平在各组间的差异及其与胰岛素抵抗、血糖、体脂等因素的相关性。结果1.T2DM非腹型肥胖组晨血皮质醇高于正常对照组,ACTH高于正常对照组;晨血皮质醇水平与FPG、GHbAlc、FINS,HOMA-IR呈正相关。将与皮质醇相关的因素和晨血皮质醇水平进行多元逐步回归分析,结果显示HOMA-IR与高皮质醇水平密切相关。2.T2DM腹型肥胖组晨血皮质醇、ACTH水平均高于正常对照组,ACTH水平高于非腹型肥胖组,晨血皮质醇水平与BMI、WHR、FPG、GHbAlc、FINS,HOMA-IR呈正相关,晨血ACTH水平与晨血皮质醇水平、BMI、FPG、FINS,HOMA-IR呈正相关,多元逐步回归分析表明T2DM腹型肥胖组的高皮质醇水平与高血糖关系最为密切,高ACTH水平与HOMA-IR密切相关。3.T2DM非腹型肥胖组与T2DM腹型肥胖组均存在垂体-肾上腺轴昼夜分泌节律的紊乱。结论1.T2DM患者存在垂体-肾上腺轴功能的异常。2.腹型肥胖与非腹型肥胖的2型糖尿病患者血清皮质醇、ACTH水平可能高于正常对照组,而且昼夜节律性消失。3.T2DM腹型肥胖者的高皮质醇、高ACTH可能与高血糖及胰岛素抵抗状态密切相关。血清皮质醇、血糖和GHbAlC的联合检测对临床上伴有腹型肥胖的T2DM患者的评估和治疗具有指导意义,且可以考虑从糖皮质激素入手改善胰岛素的敏感性。更多还原

【Abstract】 Objective1.To evaluate the abnormalities of serum cortisol and ACTH in patients with Type 2 Diabetes Mellitus of different stature.2.To evaluate the abnormalities of serum cortisol and ACTH in relation to development of insulin resistance.MethodsFifty T2DM subjects were grouped to patients with abdominal obesity and patients without abdominal obesity according to their Waist circumference(WC),Hip circumference(HC),waist-to-hip ratio(WHR),body mass index(BMI),serum cortisol and ACTH at 8am and 4pm,fasting plasma glucose(FPG),GHbA1c,insulin,and some other related index were measured in the subjects.HOMA-insulin resistance was calculated from the formula IR=fasting blood sugar×fasting insulin/22.5.To compare the difference of serum cortisol and ACTH among the groups and the abnormalities of serum cortisol and ACTH in relation to development of insulin resistance.Results1.Patients without abdominal obesity displayed higher plasma cortisol concentrations and higher plasma ACTH compared to normal control.The higher plasma cortisol concentrations was positively associated with FPG,GHbA1c、FINS and HOMA-IR.Further analysis revealed that HOMA-IR is the strongest factor associated with serum cortisol.2.In patients with abdominal obesity,both cortisol and ACTH concentrations are higher than normal control,and the ACTH concentrations are higher than the ACTH concentrations in the patients without abdominal obesity.The high level of cortisol was positively associated with hyperglycemia,and the high level of ACTH was positively associated with insulin resistance.3.All the patients of T2DM display abnormal circadian rhythms of cortisol and ACTH secretion.ConclusionsAll the patients of T2DM display abnormal circadian rhythms of cortisol and ACTH secretion.Patients with or without abdominal obesity displayed higher serum cortisol concentrations and higher serum ACTH compared to normal control,and the high level of cortisol and ACTH was closely associated with hyperglycemia and insulin resistance.更多还原