Analysis of hypothalamic-pituitary-adrenal axis function in type 2 diabetes mellitus patients combined with depression with different courses / 中国医师进修杂志

ABSTRACT

Objective To analyze the hypothalamic-pituitary-adrenal axis function in type 2 diabetes mellitus(T2DM) patients combined with depression with different courses.Methods Forty T2DM without depression patients (T2DM without depression group) and 42 T2DM combined with depression patients (T2DM combined with depression group) were divided into 3 groups according to the courses＜ 5years,5-15 years,＞ 15 years.Thirty healthy person were selected as control group.The levels of serum adrenocorticotropic hormone (ACTH),cortisol (Cor),fasting blood glucose (FPG),glycosylated hemoglobin (HbA1c),24 h urinary-free cortisol (UFC) were determined at 800 Am.Results The levels of serum ACTH,24 h UFC in T2DM without depression group were higher than those in control group [(241.7 ±132.6) pg/L vs.(174.1 ± 108.2) pg/L and (96.67 ± 15.92) μg vs.(76.04 ±24.60) μg],and there were significant differences (P ＜ 0.05 or ＜ 0.01).There were no significant differences in the levels of serum ACTH,Cor,24 h UFC among ＜ 5 years,5-15 years,＞ 15 years in T2DM without depression group (P＞0.05).The levels of serum Cor,24 h UFC in T2DM combined with depression group were higher than those in T2DM without depression group and control group,and there were significant differences (P ＜ 0.01),but compared with those in T2DM without depression group with the same courses,only ACTH was different in ＜5 years (P ＜ 0.01),Cor,24 h UFC was different in ＞ 15 years (P ＜ 0.01).There was significant difference in the level of serum ACTH between ＜ 5 years and 5-15 years,＞ 15 years in T2DM combined with depression group (P ＜ 0.01),Cor had no difference among different courses (P ＞ 0.05),24 h UFC had difference between ＞ 15 years and ＜ 5 years,5-15 years (P＜ 0.01 or ＜ 0.05).In T2DM without depression group,the level of serum Cor was positively correlated with FPG (P ＜ 0.01),the level of serum ACTH was positively correlated with FPG (P ＜0.05).In T2DM combined with depression group,the level of serum Cor was positively correlated with FPG,HbA1c (P ＜ 0.01),the level of serum ACTH was no relationship with others,the level of serum 24 h UFC was positively correlated with FPG,HbA1c (P＜ 0.01).Conclusion With the prolonged courses of diabetes,the function of hypothalamic-pituitary-adrenal axis gets worse in T2DM patients combined with depression.