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目的 观察库欣综合征患者、肥胖症者和正常人血清脂联素昼夜节律及糖皮质激素、胰岛素和瘦素对其影响。方法 15例库欣综合征病人、10例单纯性肥胖症病人和 9例正常人 ,每 4h抽血 1次 ,测定 1d内的血清脂联素、皮质醇、胰岛素和瘦素的昼夜节律。同时观察地塞米松抑制试验对脂联素水平的影响。结果 库欣综合征病人、肥胖症者及正常人血清脂联素昼夜节律皆不明显 ,但肥胖症者 6个时间点脂联素水平显著低于正常人。脂联素曲线下面积与体重指数 (BMI)、腰围、腰臀围比和胰岛素曲线下面积呈显著负相关 (r值分别为 - 0 4 6、- 0 33、- 0 38、- 0 36 ,P值均 <0 0 5 ) ,而与瘦素的相关性尚未达到统计学差异 ,与皮质醇曲线下面积亦无相关性。 1、2、8mg地塞米松抑制试验对血清脂联素的影响皆不大 ,但库欣综合征病人术后第 1天脂联素水平明显低于术前。结论 血清脂联素水平与BMI、腰围呈负相关 ,既不受皮质醇昼高夜低的分泌节律影响 ,也不随餐后胰岛素释放的增加而变化 ,但术后的应激反应可能减少脂联素的分泌。
Objective To observe the circadian rhythm of serum adiponectin, glucocorticoid, insulin and leptin in Cushing’s syndrome, obesity and normal people. Methods Fifteen patients with Cushing’s syndrome, 10 patients with simple obesity and 9 normal controls were enrolled in this study. Blood was taken every 4 hours and the circadian rhythm of serum adiponectin, cortisol, insulin and leptin was determined within 1 day. Meanwhile, the effect of dexamethasone inhibition test on adiponectin level was also observed. Results Serum adiponectin had no obvious circadian rhythm in patients with Cushing’s syndrome, obesity and normal subjects, but adiponectin levels were significantly lower than those in normal subjects at 6 time points. The area under the curve of adiponectin was negatively correlated with the body mass index (BMI), waist circumference, waist-hip ratio and area under the curve of insulin (r values were -0.46, -0.33, -0.038, -0.36, P values were all <0 05), while the correlation with leptin has not yet reached statistical significance, nor with the area under the curve of cortisol. 1,2,8 mg dexamethasone inhibition test on serum adiponectin are not large, but Cushing’s syndrome on the first postoperative day adiponectin levels were significantly lower than preoperative. Conclusions The level of serum adiponectin is negatively correlated with BMI and waist circumference. It is neither affected by the secretive rhythm of cortisol during high day and night, nor with the increase of postprandial insulin release. However, the postoperative stress response may reduce the adiposity Su secretions.