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目的 :探讨褪黑素对糖尿病应激状态垂体 肾上腺轴功能影响及改善糖代谢紊乱作用的神经内分泌机制。方法 :采用随机、单盲、安慰剂平行对照的方法 ,连续观察 3天外源性褪黑素及安慰剂对 37例糖尿病急性并发症患者垂体 肾上腺轴及糖尿病急性代谢紊乱相关指标的影响 ;并观察给药两周后患者糖代谢控制情况。结果 :①患者下丘脑 垂体 肾上腺 (HPA)轴处于激活状态 ,于药物干预前血浆ACTH和皮质醇水平均高于正常值 ,两组间血浆ACTH和皮质醇水平的差异无显著意义 (P >0 .0 5 ) ;②药物干预后第 1天两组间血浆ACTH和皮质醇水平均有所下降 ,但差异无显著意义 (P >0 .0 5 ) ;药物干预后第 2天和第 3天褪黑素组血浆ACTH和皮质醇下降程度均明显高于安慰剂组 ,两组间差异具显著意义 (P <0 .0 5 ) ;③药物预后 3d内褪黑素对血浆血糖、HCO3 -、阴离子间隙及血浆渗透压等糖尿病急性代谢紊乱相关指标无明显影响。给药两周后褪黑素组患者血浆空腹血糖、餐后血糖及果糖胺水平均较安慰剂组明显下降 ,两组间差异具显著意义 (P <0 .0 5 )。结论 :褪黑素对糖尿病应激状态垂体 肾上腺功能有一定抑制作用 ,适度的抑制糖尿病急性并发症患者HPA轴功能可能对糖代谢的控制及疾病预后转归有利。
Objective: To investigate the neuroendocrine mechanism of melatonin on diabetic rats with stress-induced pituitary-adrenal axis and the improvement of glucose metabolism disorder. Methods: A randomized, single-blind and placebo-controlled parallel method was used to observe the effect of 3-day exogenous melatonin and placebo on the indexes related to acute hypopituitarism of the pituitary-adrenal axis and diabetes mellitus in 37 diabetic patients with acute complications. Two weeks after administration, patients with glucose metabolism control. RESULTS: The hypothalamic pituitary adrenal axis (HPA) axis was activated. Plasma ACTH and cortisol levels were higher than normal before intervention. There was no significant difference in plasma ACTH and cortisol levels between the two groups (P> 0 .0 5); ② Plasma ACTH and cortisol levels decreased on the first day after drug intervention, but the difference was not significant (P> 0.05); on the 2nd and 3rd day after the drug intervention Melatonin plasma ACTH and cortisol levels were significantly higher than placebo group, the difference between the two groups was significant (P <0. 05); ③ drug prognosis of 3d melatonin on plasma glucose, HCO3 - Anion gap and plasma osmolality and other indicators of diabetes related to acute metabolic disorders had no significant effect. Fasting plasma glucose, postprandial plasma glucose and fructosamine in melatonin group were significantly lower than those in placebo group after two weeks of treatment. The difference between the two groups was significant (P <0.05). CONCLUSION: Melatonin has certain inhibitory effect on pituitary adrenal function in diabetic stress. Moderate inhibition of HPA axis function in patients with acute complications of diabetes may be beneficial to the control of glucose metabolism and prognosis of disease.