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目的探讨不同血糖平均水平T2DM患者下丘脑-垂体-肾上腺(HPA)轴激素与褪黑素(MLT)的关系。方法将90例T2DM患者根据HbA1c水平分为HbA1c<7%组28例、7%≤HbA1c≤10%组32例和HbA1c>10%组30例,另选取健康对照(NC)组30名,分析不同HbA1c水平内源性MLT与HPA轴激素的关系。结果 (1)HbA1c<7%组和NC组HPA轴激素、MLT水平相对较低,而7%≤HbA1c≤10%组和HbA1c>10%组相对较高。(2)多元相关分析显示,在HbA1c<7%组和NC组中,MLT与促肾上腺皮质激素(CRH)呈正相关(r=0.476、0.487,P均<0.05);在7%≤HbA1c≤10%组和HbA1c>10%组MLT与血清皮质醇(CORS)呈正相关(r=0.318、0.047,P均<0.05)。(3)多元逐步回归分析表明,T2DM患者血清CRH、促肾上腺皮质激素释放激素(ACTH)、CORS是MLT升高的独立影响因素。结论不同血糖水平的T2DM患者MLT与HPA轴的关系及作用机制不同。过高的CORS可刺激MLT分泌,HPA轴与MLT相互影响,协同作用影响糖尿病的发生发展。
Objective To investigate the relationship between hypothalamus - pituitary - adrenal (HPA) axis hormone and melatonin (MLT) in T2DM patients with different mean blood glucose levels. Methods According to the level of HbA1c, 90 patients with T2DM were divided into 28 cases of HbA1c <7%, 32 cases of 7% ≤HbA1c≤10%, 30 cases of HbA1c> 10%, and 30 cases of healthy control group (NC) Relationship between endogenous MLT and HPA axis hormones at different HbA1c levels. Results (1) HbA1c <7% group and NC group HPA axis hormone, MLT level is relatively low, while 7% ≤HbA1c≤10% group and HbA1c> 10% group is relatively high. (2) Multivariate correlation analysis showed that there was a positive correlation between MLT and adrenocorticotropic hormone (CRH) in HbA1c group <7% and NC group (r = 0.476,0.487, P <0.05); in 7% ≤HbA1c≤10 MLT was positively correlated with serum cortisol (CORS) in the% and HbA1c> 10% groups (r = 0.318 and 0.047, all P <0.05). (3) Multiple stepwise regression analysis showed that serum CRH, adrenocorticotropic hormone releasing hormone (ACTH) and CORS were independent risk factors of MLT in T2DM patients. Conclusion The relationship between MLT and HPA axis and the mechanism of action in T2DM patients with different blood glucose levels are different. Excessive CORS can stimulate MLT secretion, HPA axis and MLT affect each other, synergistic effect of the occurrence and development of diabetes.