目的 分析促肾上腺皮质激素(ACTH)、皮质醇(CORT)与1型糖尿病(T1DM)患儿糖化血红蛋白(HbA1c)水平的相关性,为T1DM的临床诊断提供科学依据。 方法 选择2014年1月—2018年12月在唐山市妇幼保健院内分泌科就诊的T1DM患儿105例为T1DM组,另选同期在本院健康体检儿童105例作为对照组,采用酶联免疫吸附法检测各观察对象在1 d内各时间点(8:00、16:00、24:00)的血浆ACTH、CORT水平,Pearson相关分析法分析T1DM患儿血浆ACTH、CORT日平均水平与空腹血糖(FPG)、HbA1c等指标相关性,Logistic回归分析影响T1DM发病的因素。 结果 与对照组比较,T1DM组患儿甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、FPG与HbA1c水平显著升高,高密度脂蛋白胆固醇(HDL-C)水平降低,差异有统计学意义(P＜0.05);T1DM组患儿血浆ACTH、CORT在8:00、16:00、24:00表达水平和日平均水平显著高于对照组,差异均有统计学意义(P＜0.05);相关性分析显示,T1DM患儿血浆ACTH、CORT日平均表达水平与血浆FPG、HbA1c呈正相关(rACTH=0.717、0.585、rCORT=0.636、0.696,P<0.01);Logistic回归分析显示ACTH、CORT是T1DM患儿发病的独立危险因素。结论 ACTH、CORT在T1DM患儿血浆中高表达,其与HbA1c有一定相关性,是T1DM患儿发病的独立危险因素,可作为T1DM血糖控制好有效的评价指标。
Abstract
Objective To Analyze the correlation between adrenocorticotropic hormone(ACTH),cortisol(CORT) and glycated hemoglobin(HbA1c) levels in children with type 1 diabetes mellitus(T1DM),so as to provide scientific evidence for the clinical diagnosis of T1DM. Methods A total of 105 T1DM children hospitalized in the Department of Endocrinology of Tangshan Maternal and Child Health Hospital from January 2014 to December 2018 were selected as the T1DM group,and meanwhile 105 healthy children were selected as the control group. The levels of plasma ACTH and CORT at different time points (8:00,16:00 and 24:00) were measured by enzyme-linked immunosorbent assay (ELISA). Pearson method was used to analyze the correlation between the daily average levels of ACTH,CORT and fasting blood glucose (FPG),HbA1c and other indicators. In addition,Logistic regression analysis was used to analyze the risk factors of T1DM. Results Compared with those in the control group,the levels of triglyceride (TG),total cholesterol (TC),low density lipoprotein (LDL-C),FPG and HbA1c were significantly increased in T1DM group(P＜0.05),while the level of high-density lipoprotein (HDL-C) was decreased (P＜0.05). The expression level of ACTH and CORT at 8:00,16:00 and 24:00,and the daily average levels in plasma of T1DM group were significantly higher than those in control group (P＜0.05). Correlation analysis showed that the daily average expression levels of ACTH and CORT were positively correlated with FPG and HbA1c (rACTH=0.717,0.585, rCORT=0.636,0.696,P<0.01). Logistic regression analysis showed that ACTH and CORT were independent risk factors of T1DM. Conclusions ACTH and CORT are highly expressed in plasma of T1DM children,which are correlated with HbA1c. As independent risk factors for the onset of T1DM,ACTH and CORT may be used as potential markers for glycemic control of T1DM.
关键词
促肾上腺皮质激素 /
皮质醇 /
1型糖尿病 /
糖化血红蛋白
Key words
adrenocorticotropic hormone /
cortisol /
type 1 diabetes mellitus /
glycosylated hemoglobin
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 董瑾. 儿童1型糖尿病的发病现状与诊疗研究进展[J].中国妇幼保健,2017,32(13):3088-3090.
[2] Kapellen TM,Gausche R,Dost A,et al.Children and adolescents with type 1 diabetes in Germany are more overweight than healthy controls:results comparing DPV database and CrescNet database[J].J Pediatr Endocrinol Metab,2014,27(4):209-214.
[3] 王星,齐曦明,王娜,等.新诊断2型糖尿病患者胰岛素强化治疗对肾上腺皮质及交感-肾上腺髓质功能的影响[J].中国糖尿病杂志,2016,24(3):37-39.
[4] Ding L,Xu Y,Liu S,et al.Hemoglobin A1c and diagnosis of diabetes[J].J Diabetes,2018,10(5):365-372.
[5] 中华医学会糖尿病学分会. 中国1型糖尿病诊治指南(节选)[J].糖尿病天地·临床旬刊,2013,7(1):6-21.
[6] 黄晓燕,陈积雄,郑丕媚,等.儿童1型糖尿病外周血中微小RNA-155和T细胞免疫球蛋白黏蛋白分子3的表达关系及临床意义[J].中国糖尿病杂志,2019,27(8):597-601.
[7] 凌萍,章燕,骆斯慧,等.青少年儿童1型糖尿病患者血糖达标相关因素分析[J].中华医学杂志,2018,98(46):3762-3766.
[8] 刘璨璨,董再全,周亚玲,等.HPA,HPT轴在焦虑障碍合并糖尿病中的作用研究[J].四川大学学报(医学版),2017,48(6):895-899.
[9] Sharma AN,Wigham J,Veldhuis JD. Corticotropic axis drive of overnight cortisol secretion is suppressed in adolescents and young adults with type 1 diabetes mellitus[J].Pediatr Diabetes,2014,15(6):444-452.
[10] Sharma AN,Wigham J,Veldhuis JD. Corticotropic axis drive of overnight cortisol secretion is suppressed in adolescents and young adults with type 1 diabetes mellitus[J].Pediatr Diabetes,2014,15(6):444-452.
[11] Dauvermann MR,Donohoe G. Cortisol stress response in psychosis from the high-risk to the chronic stage:a systematic review[J].Ir J Psychol Med,2019,36(4):305-315.
[12] 王凡,张正红,肖开转,等.下丘脑-垂体-肾上腺轴和下丘脑-垂体-卵巢轴在多囊卵巢综合征神经内分泌功能紊乱中的作用[J].中国医学科学院学报,2017,39(5):699-704..
[13] 韩立,潘瑜,何茳萍,等.糖尿病与下丘脑-垂体-肾上腺轴功能关系的系统评价[J].中华内分泌代谢杂志,2016,32(8):668-673.
[14] 文益江,郭佳,周智广,等.青少年1型糖尿病伴阳性抑郁症状患者血清皮质醇变化特点[J].中国当代儿科杂志,2015,17(10):1098-1102.
[15] Johnson SR,Cooper MN,Jones TW,et al.Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study[J].Diabetologia,2013,56(11):2392-2400.
基金
2020年度河北省医学科学研究课题计划(20201470)
PDF(666 KB)
