【摘要】 目的探讨2型糖尿病患者早期垂体-肾上腺轴的改变与胰岛素抵抗(IR)的关系。方法采用化学发光等方法测定67例新诊断的2型糖尿病患者和33名志愿者(对照组)的血皮质醇(F)和促肾上腺皮质激素(ACTH)(8Am、4Pm和地米抑制后次8Am)以及血清胰岛素(INS)、C肽(C-P)和血糖水平;按HOMA模型计算胰岛素抵抗指数HOM-IR=FINS×FBG/22.5,以此反映2型糖尿病患者IR的情况。结果①2型糖尿病患者8Am血浆F和ACTH、4Pm和地米抑制后次8Am血浆F、血糖、INS、C-P水平以及HOMA-IR均明显高于对照组(P<0.01);②4Pm和地米抑制后次8Am血浆ACTH水平显著低于对照组;③直线相关统计分析显示,皮质醇浓度的升高与空腹血糖升高呈正相关(r=0.48,P<0.01)。与HOMA-IR的升高无直线相关性。结论2型糖尿病患者早期呈现ACTH、皮质醇过度分泌和慢性垂体-肾上腺轴功能紊乱,诱发并加重了糖代谢紊乱和胰岛素抵抗。更多还原

【Abstract】 Objective To investigate the relationship between changes of pituitary-adrenal axis function and development of insulin resistance in patients with early DM2.Methods Formal oral glucose tolerance test was performed in 67 patients with recently diagnosed DM2(within one year)and 33 controls,with blood sugar,insulin,C-peptide and cortisol levels repeatedly determined(with CLIA except oxidase method for blood sugar).Serum ACTH and cortisol levels were determined with CLIA at 8Am,4Pm and next 8Am after oral 1mg dexamethasone at midnight.HOMA-insulin resistance was calculated from the formula IR=fasting blood sugar×fasting insulin/22.5.Results The blood glucose,insulin,C-peptide and cortisol levels in diabetic patients during the oral glucose tolerance test were significantly higher than those corresponding values in controls(P<0.01).The cortisol levels were positively correlated with the fasting sugar levels(r=0.48,P<0.01),but not so with HOMA-IR.Conclusion Hypersecretion of cortisol with derangement of pituitary-adrenal axis function is present in early diabetes,this may be related in some way to the development of insulin resistance.更多还原