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目的探讨下丘脑-垂体-肾上腺轴(HPA轴)、下丘脑-垂体-甲状腺轴(HPT轴)在焦虑障碍合并糖尿病中的可能中介作用。方法选取562例住院焦虑障碍患者作为研究对象。测量其促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总四碘甲状腺原氨酸(TT4)、游离四碘甲状腺原氨酸(FT4)、促肾上腺皮质激素(ACTH)、皮质醇(PTC)等神经内分泌指标,同时进行口服葡萄糖糖耐量实验(oral glucose tolerance test,OGTT)。计算胰岛素抵抗指数(HOMA IR)、胰岛素敏感指数(WBISI)。结果焦虑障碍共病糖尿病患者83例(14.8%)。在<40岁人群中,FT4、HPT轴异常与焦虑障碍患者糖尿病患病率有关(P<0.05)。年龄(OR=1.067,95%CI:1.041~1.094,P=0.000)、FT4(OR=1.104,95%CI:1.022~1.193,P=0.012)、PTC(OR=1.001,95%CI:1.000~1.003,P=0.025)是焦虑障碍伴发糖尿病的影响因素。当PTC、HPA轴异常时,HOMA IR增高、WBISI降低(P<0.05);当ACTH、HPT轴、FT4、TT3异常时WBISI降低(P<0.05)。结论 HPA或HPT轴的异常可能是焦虑障碍伴发糖尿病的中介机制,早期关注并干预神经内分泌异常可能有助于防范焦虑障碍患者糖尿病的发生。
Objective To investigate the possible mediators of hypothalamic-pituitary-adrenal axis (HPA axis), hypothalamic-pituitary-thyroid axis (HPT axis) in the treatment of anxiety disorders with diabetes mellitus. Methods 562 patients with in-hospital anxiety disorder were selected as the research object. Thyrotropin (TSH), total triiodothyronine (TT3), free triiodothyronine (FT3), total tetraiodothyronine (TT4), free tetraethionine FT4, ACTH and PTC. Oral glucose tolerance test (OGTT) was also performed. Calculated insulin resistance index (HOMA IR), insulin sensitivity index (WBISI). Results 83 cases of anxiety disorder comorbid diabetes (14.8%). In <40 years of age, the abnormalities of FT4 and HPT axis were associated with the prevalence of diabetes in anxiety disorders (P <0.05). (OR = 1.067, 95% CI: 1.041-1.094, P = 0.000), FT4 (OR = 1.104, 95% CI: 1.022-1.1931, P = 0.012) 1.003, P = 0.025) are the influencing factors of anxiety disorder associated with diabetes. When PTC and HPA axis were abnormal, HOMA IR was increased and WBISI was decreased (P <0.05). WBISI was decreased when ACTH, HPT axis, FT4 and TT3 were abnormal (P <0.05). Conclusions Abnormal HPA or HPT axis may be an intermediate mechanism of anxiety disorder with diabetes mellitus. Early attention and intervention of neuroendocrine abnormalities may help to prevent diabetes in patients with anxiety disorders.