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目的:观察糖皮质激素治疗对21-羟化酶缺陷症(21-OHD)患者发生胰岛素抵抗(IR)的影响。方法:回顾分析确诊的21-OHD患者45例的临床资料,接受糖皮质激素治疗的28例为观察组,其余17例为对照组。比较两组空腹血糖(FBG)、空腹胰岛素(FINS)、促肾上腺皮质激素(ACTH)、17α羟孕酮(17αOHP)、睾酮(T)等水平差异及IR发生情况,并分析发生IR的影响因素。结果:观察组17αOHP水平及体质指数(BMI)显著高于对照组(P<0.05),胰岛素敏感性指数(ISI)及定量胰岛素敏感性检测指数(QUICKI)显著低于对照组(P<0.05);观察组17αOHP<10ng/ml,与本组内17αOHP≥10ng/ml比较,BMI、HOMA-IR均差异不显著(P>0.05);与对照组中17αOHP≥10ng/ml比较,T水平非常显著降低(P<0.01),但BMI、FINS、HOMA-IR均显著增加,ISI和QUICKI显著下降(P<0.05)。Pearson偏相关分析结果显示,HOMA-IR与BMI正相关;校正BMI影响后,HOMA-IR、FINS与T水平呈显著正相关(P<0.05)。多因素Logistic回归分析结果显示,BMI与HOMA-IR显著相关(P<0.05)。结论:高皮质醇血症和高雄激素血症均与21-OHD患者的IR有关,糖皮质激素治疗可增加21-OHD患者的BMI,进而增加了患者发生IR的概率。
Objective: To observe the effects of glucocorticoid therapy on insulin resistance (IR) in 21-OHD patients. Methods: The clinical data of 45 patients diagnosed with 21-OHD were retrospectively analyzed. 28 patients receiving glucocorticoid were treated as observation group and the other 17 patients as control group. The levels of fasting blood glucose (FBG), fasting insulin (FINS), adrenocorticotropic hormone (ACTH), 17αOHP, testosterone (T) and the incidence of IR were compared between the two groups and the influencing factors of IR . Results: 17αOHP and BMI in the observation group were significantly higher than those in the control group (P <0.05), while ISI and QUICKI in the observation group were significantly lower than those in the control group (P <0.05) ; The observation group 17αOHP <10ng / ml, compared with 17αOHP≥10ng / ml in this group, BMI, HOMA-IR showed no significant difference (P> 0.05); Compared with the control group 17αOHP ≥ 10ng / ml, T level was very significant (P <0.01), but BMI, FINS and HOMA-IR increased significantly, and ISI and QUICKI decreased significantly (P <0.05). Pearson partial correlation analysis showed that there was a positive correlation between HOMA-IR and BMI. After adjusting for BMI, there was a significant positive correlation between HOMA-IR, FINS and T (P <0.05). Multivariate Logistic regression analysis showed that BMI was significantly associated with HOMA-IR (P <0.05). CONCLUSIONS: Both hyperhomocysteinemia and hyperandrogenism are associated with IR in 21-OHD patients. Glucocorticoid therapy increases the BMI in 21-OHD patients and increases the probability of IR in patients.