目的 了解青少年1 型糖尿病(T1DM)伴阳性抑郁症状患者的血清皮质醇变化特点。方法 对28 例青少年T1DM 患者和31 例健康同龄人采用流调中心用抑郁自评量表筛查阳性抑郁症状者,分为T1DM 伴阳性抑郁症状组(15 例)、单纯T1DM 组(13 例)、单纯阳性抑郁症状组(15 例)和正常对照组(16例)。比较各组清晨空腹血清皮质醇水平,并运用Pearson 相关分析法分析T1DM 患者血清皮质醇和糖化血红蛋白(HbA1c)与抑郁症状得分的相关性。结果 与31 例健康同龄人相比,28 例T1DM 患者平均清晨空腹血清皮质醇水平明显升高(P<0.01)。与单纯阳性抑郁症状组和正常对照组比较,T1DM 伴阳性抑郁症状组患者清晨空腹血清皮质醇水平均明显升高(P<0.01)。T1DM 患者血清HbA1c 值与其抑郁症状得分呈正相关(r=0.481,P=0.010)。结论 青少年T1DM 伴阳性抑郁症状患者清晨空腹血清皮质醇水平明显升高,提示两者共病患者的肾上腺皮质激素释放激素-促肾上腺皮质激素-皮质醇轴功能受损。青少年T1DM 患者阳性抑郁症状的发生与糖代谢控制不良有关。
Abstract
Objective To study the changes in serum cortisol levels in adolescents with type 1 diabetes (T1DM) and elevated depressive symptoms. Methods Twenty-eight adolescents with T1DM and 31 healthy peers were assessed for depressive symptoms using a depression self-rating scale developed by the Epidemiological Survey Center. Selected subjects were classified into four groups:T1DM with elevated depressive symptoms group (n=15), T1DM without elevated depressive symptoms group (n=13), elevated depressive symptoms without T1DM group (n=15), and normal control group (n=16). Fasting blood samples were collected in the morning, and the levels of serum cortisol were compared among the four groups. The correlations of serum levels of cortisol and glycosylated hemoglobin A1c (HbA1c) with the score of depression self-rating scale were evaluated by Pearson correlation analysis. Results The fasting serum cortisol levels in the 28 T1DM patients were significantly higher than in the 31 healthy peers (P<0.01). The fasting cortisol levels in the T1DM with elevated depressive symptoms group were significantly higher compared with those in the elevated depressive symptoms without T1DM group and normal control group (P<0.01). In adolescents with T1DM, serum HbA1c level was positively correlated with the score of depression self-rating scale (r=0.481, P=0.010). Conclusions The fasting serum cortisol levels in adolescents with T1DM and elevated depressive symptoms are significantly increased, suggesting that the patients with comorbidity of T1DM and depression develop dysfunction of the corticotropin-releasing hormone-adrenocorticotropic hormone-cortisol axis. The elevated depressive symptoms may be associated with a poor control of glucose metabolism.
关键词
1 型糖尿病 /
抑郁症状 /
皮质醇 /
糖化血红蛋白 /
青少年
Key words
Type 1 diabetes /
Depressive symptom /
Cortisol /
Glycosylated hemoglobin A1c /
Adolescent
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 陈再英, 钟南山. 内科学[M]. 第7 版. 北京:人民卫生出版社, 2008:770.
[2] Li XH, Li TL, Yang Z, et al. A nine-year prospective study on the incidence of childhood type 1 diabetes mellitus in China[J]. Biom Environ Sci, 2000, 13(4):263-270.
[3] American Diabetes Association. American Diabetes Association Practice Guidelines[J]. Diabetes Care, 2009, 32(Suppl 1):3-12.
[4] 郑琴, 朱跃兰, 侯秀娟. 类风湿性关节炎伴发抑郁动物模型的建立[J]. 吉林中医药, 2009, 29(8):720-722.
[5] 马静, 禹顺英, 梁珊, 等. MAOA-u VNTR 多态性单独及和应激性生活事件交互作用与青少年重性抑郁障碍的关联分析[J]. 中国当代儿科杂志, 2013, 15(7):563-568.
[6] 王晓丽, 贾正平, 张汝学, 等. HPA 轴功能紊乱干预药物的研究进展[J]. 西北药学杂志, 2013, 28(5):546-549.
[7] 孙艳, 马维青, 孔晓明, 等. 2 型糖尿病合并抑郁患者血皮质醇水平变化的研究[J]. 安徽医科大学学报, 2007, 42(l):70-73.
[8] Jaser S, Whittemore R, Ambrosino J, et al. Mediators of depressive symptoms in children with type1 diabetes and their mothers[J]. J Pediatr Psychol, 2008(33):509-519.
[9] 傅强, 赵鹏, 喻东山. 抑郁症患者血清皮质醇水平分析[J]. 中国实用医药, 2007, 2(3):20-22.
[10] 郭佳, 文益江, 何国平, 等. 基于access 软件的问卷调查法应用于护理研究中的可行性探讨[J]. 护理学杂志, 2014, 29(16):62-64.
[11] 张宝山, 李娟. 简版流调中心抑郁量表在全国成年人群中的信效度[J]. 中国心理卫生杂志, 2011, 25(7):506-511.
[12] 徐乐平, 纪菊英, 宋梓祥, 等. 抑郁症伴或不伴糖尿病患者过夜小剂量地塞米松抑制试验的对照研究[J]. 中华精神科杂志, 2011, 44(5):112-115.
[13] 王茜帆, 刘冬年, 许行健, 等. 抗抑郁药对伴发抑郁障碍2 型糖尿病患者的疗效[J]. 现代实用医学, 2003, 15(4):218-220.
[14] Nemeroff CB, Vale WW. The neurobiology of depression:inroads to treatment and new drug discovery[J]. J Clin Psych, 2005, 66(Supp7):5-13.
[15] Guo J, Whittemore R, Grey M, et al. Diabetes self-management, depressive symptoms, metabolic control, and quality of life in youths with type 1 diabetes in China:a cross-sectional descriptive study[J]. J Clin Nurs, 2013, 22(1-2):69-79.
[16] 巩纯秀, 曹冰燕, 李豫川. 对儿童青少年1 型糖尿病代谢控制状况的再评估[J]. 中国糖尿病杂志, 2008, 16(3):172-174.
[17] 王婧. 湖南省儿童青少年1 型糖尿病患者抑郁症状及生活质量总体满意度的研究[D]. 长沙:中南大学, 2011.
[18] Moussa MMA, Alsaeid M, Abdella N, et al. Social and psychological characteristics of Kuwaiti children and adolescents with type 1diabetes[J]. Soc Sci Med, 2005, 60(8):1835-1844.
[19] 彭鑫, 崔焱. 糖尿病儿童青少年心理行为问题及与代谢控制关系的研究进展[J]. 护理研究, 2010, 24(4):847-849.
[20] 王爱华, 朱逞, 洪宝瑟, 等. 情绪障碍对1 型糖尿病儿童代谢控制及治疗依从性的影响[J]. 实用儿科临床杂志, 2007, 22(14):1081-1082.
[21] 巩纯秀. 123 例18 岁以下l 型糖尿病病人管理状况的评估[J]. 中华糖尿病杂志, 2003, 11(3):172-175.
[22] 高寒, 牛尤敏, 高启惠. 2 型糖尿病患者的心理问题与糖尿病代谢控制的关系[J]. 菏泽医学专科学报, 2010, 22(1):8-9.
基金
国家第52批中国博士后科学基金面上资助二等资助项目(2012M521537);2012年湖南省科技资助计划博士后基金(2012RS4025)。
PDF(1423 KB)
