CAJ | 학술논문

目的探讨初发2型糖尿病患者焦虑抑郁对唾液皮质醇水平的影响.方法以85名正常人(NC组)及93例糖调节受损患者(IGR组)为对照,研究108例初发2型糖尿病患者(T2DM组)的精神心理状况和皮质醇水平的关系.各组受试者进行问卷调查,包括Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS),酶联免疫法测定空腹血浆皮质醇及唾液皮质醇水平.结果 (1)各组间焦虑分有统计学差异(P<0.01),其中,焦虑的发生率在三组间也有差异(χ2=7.245,P<0.05),T2DM组明显高于IGR组及NC组.(2)三组间抑郁分的差异有统计学意义(P<0.01),T2DM组、IGR组高于NC组,抑郁发生率T2DM组、IGR组高于NC组(χ2=8.179,P<0.05).(3)三组血浆皮质醇、唾液皮质醇无统计学差异,相关分析显示唾液皮质醇水平与BMI、HbA1c呈正相关(r=0.467,P<0.01;r=0.249,P<0.05),与血浆皮质醇呈显著正相关(r=0.872,P<0.01).T2DM组中焦虑抑郁者其唾液皮质醇水平高于无焦虑抑郁者(P<0.05),Logistic逐步回归分析示,T2DM患者中,与焦虑相关的因素有唾液皮质醇、空腹血糖及HbA1c;与抑郁相关的因素有唾液皮质醇、HbA1c及性别.结论初发T2DM患者伴焦虑、抑郁者皮质醇水平增高,下丘脑-垂体-肾上腺轴功能亢进可能是其易于出现焦虑、抑郁情绪的重要神经内分泌因素之一.唾液皮质醇是评价肾上腺皮质功能的重要检测手段之一.
목적 탐토초발2형당뇨병환자초필억욱대타액피질순수평적영향.방법 이85명정상인(NC조)급93례당조절수손환자(IGR조)위대조,연구108례초발2형당뇨병환자(T2DM조)적정신심리상황화피질순수평적관계.각조수시자진행문권조사,포괄Zung초필자평량표(SAS)、Zung억욱자평량표(SDS),매련면역법측정공복혈장피질순급타액피질순수평.결과 (1)각조간초필분유통계학차이(P<0.01),기중,초필적발생솔재삼조간야유차이(χ2=7.245,P<0.05),T2DM조명현고우IGR조급NC조.(2)삼조간억욱분적차이유통계학의의(P<0.01),T2DM조、IGR조고우NC조,억욱발생솔T2DM조、IGR조고우NC조(χ2=8.179,P<0.05).(3)삼조혈장피질순、타액피질순무통계학차이,상관분석현시타액피질순수평여BMI、HbA1c정정상관(r=0.467,P<0.01;r=0.249,P<0.05),여혈장피질순정현저정상관(r=0.872,P<0.01).T2DM조중초필억욱자기타액피질순수평고우무초필억욱자(P<0.05),Logistic축보회귀분석시,T2DM환자중,여초필상관적인소유타액피질순、공복혈당급HbA1c;여억욱상관적인소유타액피질순、HbA1c급성별.결론 초발T2DM환자반초필、억욱자피질순수평증고,하구뇌-수체-신상선축공능항진가능시기역우출현초필、억욱정서적중요신경내분비인소지일.타액피질순시평개신상선피질공능적중요검측수단지일.
Objective To explore the relationship between cortisol secretion and anxiety/depressive disorders in newly diagnosed type 2 diabetic patients. Methods According to the results of 75g oral glucose tolerance test,all subjects were divided into diabetes mellitus (DM) group, impaired glucose regulation(IGR) group and normal glucose tolerance(NC) group.Serum and salivary cortisol level were measured by ELISA.85 healthy adults,93 patients with IGR and 108 diabetic patients were questionnaired by using SAS and SDS.The correlation of psychological state and cortisol secretion were analyzed. Results （1）There were differencs in anxiety scores among the three groups,and anxiety scores of DM patients were higher than those of IGR patients and healthy adults. 23.1% percent of diabetic patients suffered from anxiety. The incidence of anxiety was significantly higher in DM group than in IGR and NC groups (P<0.05). （2） Both depressive scores and the incidence of depression were significantly higher in DM group and IGR group than in NC group. （3）Fasting serum and salivary cortisol level showed no significant difference among the three groups. Salivary cortisol level was positvely related to body mass index(BMI) and glycosylated hemoglobin (HbA1c). Closely positve correlation existed between salivary cortisol and serum cortisol level. Salivary cortisol level was higher in the diabetic patients with anxiety and/or depressive disorders than in DM group without the disorders（P<0.05）. Multiple regression analysis showed that the 3 factors influencing anxiety were salivary cortisol level,fasting blood glucose and HbA1c. At the same time the factors influencing depression were salivary cortisol level,HbA1c and sex. Conclusions Newly diagnosed diabetic patients contribut to with anxiety/depressive disorders more often have hypercortisolemia. Hypothalamicpituitaryadrenal axis hyperfunction could contribut to anxiety/depressive disorders in the patients.Salivary cortisol test can be recommended as a firstline sensitive and convenient parameter for glucocorticoids funtion.