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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(x~2=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(x~2=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、HbA_1c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HbA_1c;与抑郁相关的因素有唾液皮质醇、HbA_1c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。
Objective To investigate the effect of anxiety and depression on the level of salivary cortisol in newly diagnosed type 2 diabetic patients. Methods The relationship between mental health and cortisol level was investigated in 108 normal subjects with type 2 diabetes (T2DM group) and 85 normal controls (NC group) and 93 patients with impaired glucose regulation (IGR group). Subjects in each group were surveyed, including the Zung anxiety self-rating scale (SAS), the Zung depression self-rating scale (SDS), and the fasting plasma cortisol and salivary cortisol levels by enzyme-linked immunosorbent assay. Results (1) There was a significant difference in anxiety scores among the three groups (P <0.01). The incidence of anxiety was also different between the three groups (x ~ 2 = 7.245, P <0.05) And NC group. (2) There were significant differences in depression scores among the three groups (P <0.01). T2DM group and IGR group were higher than NC group. The incidence of depression was higher in T2DM group and IGR group than in NC group (x ~ 2 = 8.179, P <0.05). (3) There was no significant difference between the three groups in plasma cortisol and salivary cortisol. Correlation analysis showed that salivary cortisol level was positively correlated with BMI and HbA 1c (r = 0.467, P <0.01; r = 0.249, P < Cortisol was positively correlated (r = 0.872, P <0.01). The levels of salivary cortisol in anxiety and depression of T2DM patients were higher than those without anxiety and depression (P <0.05). Logistic stepwise regression analysis showed that the factors related to anxiety were salivary cortisol, fasting blood glucose and HbA_1c, Related factors are salivary cortisol, HbA_1c, and sex. Conclusions The level of cortisol in the newly diagnosed T2DM patients with anxiety and depression is increased. Hypothalamic-pituitary-adrenal axis hyperfunction may be one of the important neuroendocrine factors in anxiety and depression. Salivary cortisol is one of the important means to evaluate adrenocortical function.