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目的观察IGR患者肾上腺皮质的应激反应。方法对103例IGR患者(IGR组)行75gOGTT,计算ISI、胰岛素抵抗指数(HOMA-IR)、葡萄糖及胰岛素曲线下面积(AUCg,AUCi),同时检测患者血、尿皮质醇,血促肾上腺皮质激素(ACTH)等,与65名正常对照者(NC组)进行比较。结果 IGR组中高皮质醇分泌者为17.5%(18/103),NC组为10.8%(7/65)。IGR组8:00、16:00血皮质醇及尿游离皮质醇均高于NC组,差异有统计学意义(P<0.05)。伴高皮质醇分泌的IGR者AUCg高于NC组(P<0.05)。剔除性别、年龄及BMI影响因素,IGR者2hPG、AUCg、ISI及HOMA-IR等与血、尿皮质醇水平相关。结论 IGR者部分出现原发性肾上腺皮质的应激反应,高皮质醇分泌的患病率升高,血糖升高与高皮质醇分泌互为因果。
Objective To observe the stress response of adrenal cortex in patients with IGR. Methods The levels of ISI, insulin resistance index (HOMA-IR), area under the curve of glucose and insulin (AUCg, AUCi) were determined in 103 patients with IGR (IGR group). Blood, urine cortisol, blood adrenocortical Hormone (ACTH), etc., and 65 normal controls (NC group) were compared. Results The IGR group had 17.5% (18/103) of hypercortisol secretion and 10.8% (7/65) of NC group. The blood cortisol and urinary free cortisol in IGR group were significantly higher than those in NC group at 8:00 and 16:00 (P <0.05). The AUCg of IGR with high cortisol secretion was higher than that of NC group (P <0.05). Excluding gender, age and BMI factors, IGR 2hPG, AUCg, ISI and HOMA-IR and blood and urine cortisol levels. Conclusions Some patients with IGR have stress reaction of primary adrenal cortex, the prevalence of hypercortisol secretion increases, and the relationship between hyperglycemia and hypercortisol secretion is causality.