青少年1型糖尿病伴阳性抑郁症状患者血清皮质醇变化特点

Changes in fasting serum cortisol levels in adolescents with type 1 diabetes and elevated depressive symptoms

摘要:

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.