糖尿病与下丘脑—垂体—肾上腺轴功能关系的系统评价

发布时间：2018-02-24 19:23

本文关键词： 糖尿病下丘脑-垂体-肾上腺轴皮质醇库欣综合征亚临床库欣综合征高皮质醇血症　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:系统评价糖尿病与下丘脑-垂体-肾上腺轴功能的关系,为临床筛查糖尿病患者下丘脑-垂体-肾上腺轴功能提供一定的客观依据。方法:计算机检索Pub Med、Ovid、Embase、Web of Science文献数据库。检索时限为数据库建库至2014年12月31日。检索糖尿病与下丘脑-垂体-肾上腺轴功能的相关研究,按照纳入排除标准进行文献筛选、资料提取后,采用Stata12.0统计软件进行Meta分析。结果:最终纳入23项研究,包括7726例研究对象(1507例糖尿病患者和6219例对照);18项病例对照研究和5项横断面研究。Meta分析结果显示,(1)与对照组相比,总糖尿病组、T1DM组及T2DM组血基础皮质醇水平均较高,差异均有统计学意义;糖尿病伴或不伴慢性并发症组及合并高血压组血基础皮质醇水平均较高,差异均有统计学意义;糖尿病未合并高血压组血基础皮质醇无明显升高;(2)与对照组相比,糖尿病组尿24小时尿游离皮质醇(24h UFC)、血促肾上腺皮质激素(ACTH)水平均无显著差异;(3)与对照组相比,糖尿病组地塞米松抑制后血皮质醇较对照组显著升高,差异有统计学意义;(4)定性评价发现,糖尿病组与对照组之间清晨唾液皮质醇及皮质醇觉醒反应(CAR)各研究结果存在不一致。结论:该系统评价结果显示,糖尿病患者存在血基础皮质醇及地塞米松抑制后血皮质醇水平显著升高,提示可能存在HPA轴功能异常,且存在合并症可能加重HPA轴功能异常;但目前关于糖尿病患者24h UFC、血ACTH水平无显著异常;多数研究发现糖尿病患者CAR降低,也提示糖尿病患者可能存在HPA轴功能异常,但仍需进一步的临床及试验研究加以证实。
[Abstract]:Objective: to evaluate the relationship between diabetes mellitus and hypothalamus-pituitary-adrenal axis function. Objective basis was provided for clinical screening of hypothalamus-pituitary-adrenal axis function in diabetic patients. Methods: the Pub MedOvidae Embase of Science document database was searched by computer. Relationship between Hypothalamus-pituitary-adrenal axis function and chordomatous diabetes, The literature was screened according to the exclusion criteria, and the data was extracted. Meta analysis was carried out with Stata12.0 statistical software. Results: finally, 23 studies were included. The results of 18 case-control studies and 5 cross-sectional studies showed that the basal cortisol levels in T1DM group and T2DM group were higher than those in control group. The levels of basal cortisol in diabetic patients with or without chronic complications and hypertension were higher and the differences were statistically significant. Compared with the control group, there was no significant difference in the levels of urine 24 hour urinary free cortisol and ACTH between the diabetic group and the control group. After dexamethasone inhibition, serum cortisol in diabetic group was significantly higher than that in control group, the difference was statistically significant (P < 0.05). The results of early morning salivary cortisol and cortisol arousal response were different between diabetic group and control group. Serum cortisol and dexamethasone decreased significantly in diabetic patients, suggesting that there may be abnormal HPA axis function, and complications may aggravate HPA axis dysfunction. However, at present, there is no significant abnormality in serum ACTH level in patients with diabetes mellitus at 24 hours. Most studies have found that CAR is lower in diabetic patients, suggesting that there may be abnormal HPA axis function in diabetic patients, but further clinical and experimental studies are still needed to confirm it.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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