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目的:探讨冠心病(CHD)患者唾液皮质醇水平与糖代谢状况的变化及影响因素。方法:选取正常对照组(NC组)35例,将CHD患者(CHD组)98例按OGTT结果分为3组,即单纯CHD组、CHD糖调节异常组(CHD+IGR组)和CHD伴糖尿病(DM)组(CHD+DM组),采用酶联免疫法测定8AM、4PM及0AM唾液皮质醇水平,比较CHD组与NC组及各亚组之间唾液皮质醇水平差异,进一步分析其相关因素。结果:①CHD患者唾液皮质醇水平(8AM,0AM)与NC组比较差异有统计学意义(P<0.05),唾液皮质醇(4PM)、超敏C反应蛋白2组间差异无统计学意义(P>0.05)。②CHD各亚组唾液皮质醇水平(8AM)差异有统计学意义,伴IGR或DM者高于单纯CHD组(P<0.05),伴DM者超敏C反应蛋白高于伴IGR或单纯CHD组(P<0.05),0AM、4PM唾液皮质醇水平3组间差异无统计学意义(P>0.05)。③相关分析显示CHD患者8AM唾液皮质醇水平与糖化血红蛋白、超敏C反应蛋白呈正相关(r=0.327,P<0.05;r=0.215,P<0.05),与空腹血糖无关。结论:下丘脑-垂体-肾上腺轴功能失调可能是CHD患者易于出现糖代谢异常的重要参与因素,CHD患者皮质醇节律异常,可能与炎症、免疫有关,亦可能为本病进展的标志之一。
Objective: To investigate the changes of salivary cortisol and glucose metabolism in patients with coronary heart disease (CHD) and its influencing factors. Methods: A total of 98 patients with CHD (CHD group) were divided into 3 groups according to OGTT results: simple CHD group, abnormal CHD glucose regulation group (CHD + IGR group) and CHD with diabetes (CHD + DM group). The levels of salivary cortisol at 8 AM, 4 PM and 0 AM were measured by enzyme-linked immunosorbent assay (ELISA). The differences of salivary cortisol levels between CHD group and NC group and the subgroups were compared. . Results: ① The salivary cortisol levels (8 AM, 0 AM) in CHD patients were significantly different from those in NC patients (P <0.05), but there was no significant difference between saliva cortisol (4 PM) and hypersensitive C reactive protein (P > 0.05). (2) The levels of salivary cortisol (8AM) in CHD subgroups were significantly higher than those in CHD group (P <0.05), but those with IGR or DM were higher than those in CHD group (P <0.05) P <0.05). There was no significant difference in salivary cortisol levels between 0 AM and 4 PM (P> 0.05). ③ Correlation analysis showed that there was a positive correlation between salivary cortisol level of 8 AM patients and glycated hemoglobin and high sensitive C-reactive protein in CHD patients (r = 0.327, P <0.05; r = 0.215, P <0.05). Conclusion: Hypothalamic-pituitary-adrenal axis dysfunction may be an important factor for CHD patients prone to abnormal glucose metabolism. CHD patients with abnormal rhythm of cortisol may be related to inflammation and immune, and may also be one of the markers of the progress of this disease.