糖调节受损患者肾上腺皮质应激反应的观察

摘要

Objective To observe the adrenal cortical response to stress in patients with IGR.Methods One hundred and three patients with IGR were evaluated.The plasma and urinary cortisol and plasma ACTH of all the subjects were measured,and the 75 gOGTT was performed to calculate the ISI,HOMA-IR,area under the curve of glucose (AUCg) and insulin (AUCi).The results were compared between IGR and 65 non-hyperglycemic controls.Results The prevalence of increased secretion of cortisol was 17.5％ (18/103) in the patients with IGR and 10.8％ (7/65) in the control group.The 8:00 and 16:00 plasma cortisol and urinary free cortisol were higher in IGR than in control group.The IGR patients with increased secretion of cortisol had higher AUCg than did the control group (P＜0.05).Adjusting for the influence of sex,age and BMI,the 2 hPG,AUCg,ISI and HOMA-IR were correlated with the level of plasma and urinary cortisol.Conclusion The IGR patients have adrenal cortical response to stress,and those with an increased cortisol secretion have a significantly higher prevalence of diabetes.The elevation of glucose is correlated with increased secretion of cortisol in patients with IGR.%目的 观察IGR患者肾上腺皮质的应激反应. 方法 对103例IGR患者(IGR组)行75 gOGTT,计算ISI、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,与65名正常对照者(NC组)进行比较. 结果 IGR组中高皮质醇分泌者为17.5％(18/103),NC组为10.8％(7/65).IGR组8:00、16:00血皮质醇及尿游离皮质醇均高于NC组,差异有统计学意义(P＜0.05).伴高皮质醇分泌的IGR者AUCg高于NC组(P＜0.05).剔除性别、年龄及BMI影响因素,IGR者2hPG、AUCg、ISI及HOMA-IR等与血、尿皮质醇水平相关. 结论 IGR者部分出现原发性肾上腺皮质的应激反应,高皮质醇分泌的患病率升高,血糖升高与高皮质醇分泌互为因果.