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目的观察胰岛素强化治疗前后合并抑郁情绪的糖尿病患者性激素水平变化及其与情绪变化的相关性。方法选择187例2型糖尿病患者(T2DM),给予胰岛素强化治疗3个月,对入选患者治疗前后进行抑郁测定,化验其血糖、糖化血红蛋白(HbA1c)、血清性激素,并进行统计学处理。治疗期间空腹血糖(FBG)控制在4.4~6.1mmol/L,餐后2小时血糖(PBG2h)控制在4.4~8.0mmol/L之间。结果胰岛素治疗前合并抑郁情绪的男性促黄体生成素(LH)和女性泌乳素(PRL)、促卵泡生成素(FSH)明显高于无抑郁情绪患者,男性和女性雌二醇(E2)抑郁情绪患者明显低于无抑郁患者(P<0.01),睾酮(T)两者无显著差异(P>0.05);治疗后合并抑郁情绪患者抑郁指数较治疗前明显降低,合并抑郁情绪的男性LH、E2和女性PRL、FSH、E2较治疗前差异有显著性(P<0.01)。治疗前抑郁指数与男性LH和女性PRL、FSH正相关(r=0.565,0.478,0.617,P<0.01),与男性和女性E2呈负相关(r=-0.614,-0.527,P<0.05);治疗后抑郁指数下降与男性LH和女性PRL、FSH下降正相关(r=0.425,0.398,0.326,P<0.05),与男性和女性E2升高呈负相关(r=-0.357,-0.411,P<0.05)。结论胰岛素治疗可以显著改善2型糖尿病患者抑郁情绪,并且与性激素水平变化相关。
Objective To observe the changes of sex hormones and its relationship with mood changes in patients with diabetes mellitus and depression before and after insulin intensive treatment. Methods A total of 187 patients with type 2 diabetes mellitus (T2DM) were selected. Patients were given intensive insulin therapy for 3 months. Depression was measured before and after treatment. Blood glucose, HbA1c and serum sex hormones were measured and statistically analyzed. Fasting blood glucose (FBG) was controlled at 4.4-6.1 mmol / L during treatment and 4.4-8.0 mmol / L at 2 hours postprandial blood glucose (PBG2h). Results Male luteinizing hormone (LH) and female prolactin (PRL) and follicle stimulating hormone (FSH) in patients with depression before insulin treatment were significantly higher than those without depression, and the depression of estradiol (E2) in male and female patients (P <0.01), testosterone (T) showed no significant difference (P> 0.05). After treatment, the depression index of patients with depression was significantly lower than that before treatment, and the depression of male LH, E2 And female PRL, FSH, E2 than the treatment before the difference was significant (P <0.01). Before treatment, depression index was positively correlated with male LH and female PRL and FSH (r = 0.565,0.478,0.617, P <0.01), but negatively correlated with male and female E2 (r = -0.614, -0.527, P <0.05). After treatment, the decline of depression index was positively correlated with the decrease of LH and PRL and FSH of women (r = 0.425,0.398,0.326, P <0.05), but negatively correlated with the increase of E2 of men and women (r = -0.357, -0.411, P <0.05). Conclusion Insulin treatment can significantly improve depression in type 2 diabetic patients and is associated with changes in sex hormone levels.