HPA、HPT轴在焦虑障碍合并糖尿病中的作用研究

发布时间：2018-04-11 06:42

本文选题：焦虑障碍 + 糖尿病　；参考：《四川大学学报(医学版)》2017年06期

【摘要】：目的探讨下丘脑-垂体-肾上腺轴(HPA轴)、下丘脑-垂体-甲状腺轴(HPT轴)在焦虑障碍合并糖尿病中的可能中介作用。方法选取562例住院焦虑障碍患者作为研究对象。测量其促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总四碘甲状腺原氨酸(TT4)、游离四碘甲状腺原氨酸(FT4)、促肾上腺皮质激素(ACTH)、皮质醇(PTC)等神经内分泌指标,同时进行口服葡萄糖糖耐量实验(oral glucose tolerance test,OGTT)。计算胰岛素抵抗指数(HOMA IR)、胰岛素敏感指数(WBISI)。结果焦虑障碍共病糖尿病患者83例(14.8%)。在40岁人群中,FT4、HPT轴异常与焦虑障碍患者糖尿病患病率有关(P0.05)。年龄(OR=1.067,95%CI:1.041~1.094,P=0.000)、FT4(OR=1.104,95%CI:1.022~1.193,P=0.012)、PTC(OR=1.001,95%CI:1.000~1.003,P=0.025)是焦虑障碍伴发糖尿病的影响因素。当PTC、HPA轴异常时,HOMA IR增高、WBISI降低(P0.05);当ACTH、HPT轴、FT4、TT3异常时WBISI降低(P0.05)。结论 HPA或HPT轴的异常可能是焦虑障碍伴发糖尿病的中介机制,早期关注并干预神经内分泌异常可能有助于防范焦虑障碍患者糖尿病的发生。
[Abstract]:Objective to investigate the role of hypothalamus-pituitary-adrenal axis (HPA) and hypothalamus-pituitary-thyroid axis (HPT) in anxiety disorder with diabetes mellitus.Methods 562 inpatients with anxiety disorder were selected as study objects.The neuroendocrine indexes such as TSH, TT3, FT3, TT4, FT4, ACTH and PTC were measured.Oral glucose tolerance test (oral glucose tolerance test) was performed at the same time.The insulin resistance index (Homa IRI) and insulin sensitivity index (ISI) were calculated.Results there were 83 patients with diabetes mellitus with anxiety disorder.The abnormal HPT axis of FT4 was associated with the prevalence of diabetes in patients with anxiety disorder (P 0.05).1. 067 and 95: 1.041: 1.094 P0. 000 FT4: 1.022 1.193 P0. 012 are the influential factors of anxiety disorder associated with diabetes mellitus (1. 001 CI: 1. 000) and 1. 003. 0. 025 (P = 0. 025), which is a major factor in the development of diabetes mellitus (P 0. 025, P 0. 025), and it is also an important factor in the development of diabetes mellitus (P 0. 025) and anxiety disorder (1. 001: 1. 003 P0. 025).When the HPA axis of PTC was abnormal, the HOMA-IR was increased and the level of WBISI was decreased (P 0.05), while the WBISI was decreased when the T 3 was abnormal in the HPT axis of ACTH.Conclusion the abnormality of HPA or HPT axis may be the mediating mechanism of anxiety disorder associated with diabetes mellitus. Early attention and intervention of neuroendocrine abnormalities may be helpful to prevent the occurrence of diabetes in patients with anxiety disorder.
【作者单位】：四川大学华西医院心理卫生中心;
【基金】：西部精神医学协会基金(No.wcpa fund 2014-7)资助
【分类号】：R587.1;R749.72

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