垂体腺瘤患者胰岛素抵抗和皮质醇水平的相关性研究

摘要

Objective To explore the insulin resistance(IR),serum cortisol.level and circadian secretion rhythm in the patients with pituitary adenoma(PA).Methods Sixty-seven patients with PA in this hospital from October 2016 to April 2017 were selected as the observation group,including 23 cases of pituitary Cushing syndrome,15 cases of growth hormone adenoma,16 cases of prolactinoma and 13 cases of non-functioning adenoma.Contemporaneous 49 individuals undergoing healthy physical examination were selected as the control group.The biochemical indexes of fasting plasma glucose(FPG),fasting insulin(FINS) and serum cortisol were measured and the homeostasis model assessment for insulin resistance(HOMA-IR) was determined.The correlation between insulin resistance and serum cortisol was analyzed.Results The incidence rate of cortisol circadian rhythm disorder in the observation group was 58.21％,the level of fasting serum cortisol in abnormal secretion rhythm of PA group was higher than that in normal secretion rhythm of PA group and control group(P＜0.05);the levels of FINS and HOMA-IR in the pituitary Cushing syndrome and growth hormone adenoma group were higher than those in the control group,the correlation analysis showed that HOMA-IR in PA patients was positively correlated with fasting serum cortisol level and FINS level(P＜0.05).Conclusion The IR occurrence exists in pituitary Cushing syndrome and growth hormone adenoma,which may be closely correlated with serum cortisol increase.%目的 探讨垂体腺瘤(PA)患者胰岛素抵抗(IR)、血清皮质醇水平及昼夜分泌节律情况.方法 选取2016年10月至2017年4月该院收治的67例PA患者(垂体性Cushing综合征23例,生长激素腺瘤15例,泌乳素瘤16例,无功能性腺瘤13例)作为观察组,选取该院同期体检的49例健康体检者作为对照组.分别测定两组对象的空腹血糖(FPG)、空腹胰岛素(FINS)、血清皮质醇等生化指标,计算IR指数(HOMA-IR),并分析患者IR与血清皮质醇的相关性.结果 观察组皮质醇昼夜分泌节律紊乱的发生率为58.21％;皮质醇分泌节律异常的PA组患者空腹血清皮质醇水平明显高于相应的皮质醇分泌节律正常的PA组和对照组;垂体性Cushing综合征和生长激素腺瘤组的FINS水平和HOMA-IR均高于对照组,相关性分析显示,垂体性Cushing综合征和生长激素腺瘤患者的HOMA-IR与空腹血清皮质醇、FINS水平呈正相关(P＜0.05).结论 垂体性Cushing综合征和生长激素腺瘤存在IR的发生,这可能与血清皮质醇升高密切相关.