高血糖高渗状态和糖尿病酮症酸中毒时皮质醇变化的研究

发布时间：2018-11-03 17:29

【摘要】：目的:高血糖高渗状态和糖尿病酮症酸中毒时可出现血糖、血钠增高,可同时伴有血皮质醇水平的升高,易误诊为皮质醇增多症。通过对这两种糖尿病急症血皮质醇的变化趋势的动态观察,与皮质醇增多症时血皮质醇变化特点的进行分析比较,结合治疗后血糖、血钠的变化特点,与皮质醇增多症相互鉴别,为临床上进行鉴别诊断提供参考依据。方法:随机选取2型糖尿病无急性并发症患者40例,伴有糖尿病酮症酸中毒或高血糖高渗状态患者38例(其中血钠增高组18例,血钠正常组20例),分别测定8时、16时、24时血皮质醇(Cor)、空腹血糖(FBG)、空腹C肽、餐后2小时C肽、血钠的水平。并于治疗2周后复查上述结果,进行对比分析。1个月后随诊2型糖尿病急症组血皮质醇水平。结果:2型糖尿病无急症组各时段血皮质醇均正常。2型糖尿病伴急症组8时、16时、24时血皮质醇高于无急症组,差距有统计学意义(P0.05),但节律正常;2型糖尿病急症血钠增高组同血钠正常组比较8时、16时、24时血皮质醇无明显差别(P0.05)。2型糖尿病急症组治疗后血钠恢复正常水平,空腹血糖,血皮质醇较前明显下降,差距有统计学意义(P0.05)。1个月后随诊2型糖尿病急症组血皮质醇均恢复正常。结论:高血糖高渗状态和糖尿病酮症酸中毒时各时段血皮质醇均明显升高,但血皮质醇节律正常,治疗后血钠恢复正常,血皮质醇、空腹血糖较前明显下降,可与皮质醇增多症血皮质醇节律异常相鉴别。
[Abstract]:Objective: hyperglycemia and diabetic ketoacidosis may occur with increased blood glucose and sodium, and may be accompanied by an increase in serum cortisol level, which is liable to be misdiagnosed as cortisol hyperthermia. Through the dynamic observation of the change trend of serum cortisol in these two kinds of diabetes emergency, the characteristics of changes of blood cortisol in patients with cortisol were analyzed and compared, and the changes of blood glucose and sodium were combined with the changes of blood glucose and sodium after treatment. It can provide reference for clinical differential diagnosis of polycortisol syndrome. Methods: forty patients with type 2 diabetes without acute complications and 38 patients with diabetic ketoacidosis or hyperglycemia were randomly selected. 24:00 serum cortisol (Cor), fasting blood glucose (FBG), fasting C peptide, 2 hour postprandial C peptide, blood sodium level. After 2 weeks of treatment, the above results were compared and analyzed. 1 month after follow-up, the serum cortisol level in type 2 diabetes emergency group was followed up. Results: the level of cortisol was normal in type 2 diabetes mellitus without emergency group. The level of cortisol in type 2 diabetes with emergency group was higher than that in type 2 diabetes mellitus without emergency group at 8, 16:00 and 24:00, the difference was statistically significant (P0.05), but the rhythm was normal. There was no significant difference in serum cortisol between the type 2 diabetes emergency group and the normal group (P 0.05). The blood sodium returned to normal level and fasting blood glucose in the type 2 diabetes emergency group after treatment. Blood cortisol significantly decreased compared with the former, the difference was statistically significant (P0.05). 1 month after follow-up of type 2 diabetes emergency group blood cortisol returned to normal. Conclusion: in hyperglycemic hyperosmotic state and diabetic ketoacidosis, serum cortisol was significantly increased, but the rhythm of serum cortisol was normal, blood sodium returned to normal, blood cortisol and fasting blood glucose decreased significantly after treatment. It can be distinguished from abnormal rhythm of cortisol in patients with polycortisol.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.2

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