中华精神科杂志
中華精神科雜誌
중화정신과잡지
CHINESE JOURNA OF PSYCHIATRY
2011年
2期
112-115
,共4页
徐乐平%纪菊英%宋梓祥%陈琪%孙剑
徐樂平%紀菊英%宋梓祥%陳琪%孫劍
서악평%기국영%송재상%진기%손검
抑郁%糖尿病%氢化可的松%地塞米松抑制试验
抑鬱%糖尿病%氫化可的鬆%地塞米鬆抑製試驗
억욱%당뇨병%경화가적송%지새미송억제시험
Depression%Diabetes mellitus%Hydrocortisone%Dexamethasone suppression test
目的 探讨下丘脑-垂体-肾上腺轴(HPA)功能异常在抑郁症患者伴发的糖尿病发病机制中的意义.方法 首次诊断为糖尿病的抑郁症患者(病例组)、正常血糖稳态的抑郁症患者(对照组)各40例,于药物治疗前测定空腹血糖、糖负荷后2 h血糖,并行过夜小剂量(1 mg)地塞米松抑制试验.结果 (1)病例组抑制前8:00、16:00及抑制后8:00血浆皮质醇浓度分别为(608±266)、(409±176)、(382±257)nmol/L,高于对照组的(499±199)、(299±148)、(232±182)nmol/L,差异均有统计学意义(P=0.042,P:0.003,P=0.004);(2)病例组地塞米松抑制试验脱抑制率为72%(29/40),高于对照组的42%(17/40),差异有统计学意义(P=0.007);(3)病例组抑制前8:00、抑制后8:00血浆皮质醇浓度分别与空腹血糖值正相关(r=0.392,r:0.470,P均<0.05).结论 伴发糖尿病的抑郁症患者较正常血糖稳态的抑郁症患者存在更为显著的HPA功能异常,并可能是抑郁症患者伴发糖尿病的重要病理机制之一.
目的 探討下丘腦-垂體-腎上腺軸(HPA)功能異常在抑鬱癥患者伴髮的糖尿病髮病機製中的意義.方法 首次診斷為糖尿病的抑鬱癥患者(病例組)、正常血糖穩態的抑鬱癥患者(對照組)各40例,于藥物治療前測定空腹血糖、糖負荷後2 h血糖,併行過夜小劑量(1 mg)地塞米鬆抑製試驗.結果 (1)病例組抑製前8:00、16:00及抑製後8:00血漿皮質醇濃度分彆為(608±266)、(409±176)、(382±257)nmol/L,高于對照組的(499±199)、(299±148)、(232±182)nmol/L,差異均有統計學意義(P=0.042,P:0.003,P=0.004);(2)病例組地塞米鬆抑製試驗脫抑製率為72%(29/40),高于對照組的42%(17/40),差異有統計學意義(P=0.007);(3)病例組抑製前8:00、抑製後8:00血漿皮質醇濃度分彆與空腹血糖值正相關(r=0.392,r:0.470,P均<0.05).結論 伴髮糖尿病的抑鬱癥患者較正常血糖穩態的抑鬱癥患者存在更為顯著的HPA功能異常,併可能是抑鬱癥患者伴髮糖尿病的重要病理機製之一.
목적 탐토하구뇌-수체-신상선축(HPA)공능이상재억욱증환자반발적당뇨병발병궤제중적의의.방법 수차진단위당뇨병적억욱증환자(병례조)、정상혈당은태적억욱증환자(대조조)각40례,우약물치료전측정공복혈당、당부하후2 h혈당,병행과야소제량(1 mg)지새미송억제시험.결과 (1)병례조억제전8:00、16:00급억제후8:00혈장피질순농도분별위(608±266)、(409±176)、(382±257)nmol/L,고우대조조적(499±199)、(299±148)、(232±182)nmol/L,차이균유통계학의의(P=0.042,P:0.003,P=0.004);(2)병례조지새미송억제시험탈억제솔위72%(29/40),고우대조조적42%(17/40),차이유통계학의의(P=0.007);(3)병례조억제전8:00、억제후8:00혈장피질순농도분별여공복혈당치정상관(r=0.392,r:0.470,P균<0.05).결론 반발당뇨병적억욱증환자교정상혈당은태적억욱증환자존재경위현저적HPA공능이상,병가능시억욱증환자반발당뇨병적중요병리궤제지일.
Objective To explore the possible role of hypothalamic-pituitary-adrenal axis(HPA) dysfunction in mechanism of diabetes in depressive patients.Methods Two groups including depressed patients with newly diagnosed diabetes(case group,n=40),depressed patients with normal glucose homeostasis(control group,n=40)were included,and undertook overnight low-dose dexamethasone (1 mg)suppression test(LDDST)and fasting plasma glucose,2 h plasma glucose after 75 g glucose loading measurement before medication.Results The plasma cortisol levels in case group at baseline time point of 8:00 and 16:00,and 8:00 after 1 mg dexamethasone were significantly higher than that in control group[(608±266)nmol/L VS.(499±199)nmol/L;(409±176)nmol/L vs.(299±148)nmol/L;(382±257)nmol/L VS.(232±182)nmol/L;P=0.042,0.003,0.004 respectively ].The escaped suppression rates in LDDST were significantly more in case group than control group(72%vs.42%,P=0.007).Plasma cortisol levels at 8:00 before and after dexamethasone were positively correlated with fasting plasma glucose in case group(r=0.392,0.470;both P<0.05).Conclusion Depressed patients with diabetes have much severe dysfunction of the HPA axis which may play an important role in the pathomechanism of diabetes in depression.
