胰岛素强化治疗对糖尿病患者情绪的影响
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摘要
目的:T2DM患者抑郁症的发生率明显高于一般人群。一些学者认为糖尿病的病理生理改变可能是导致抑郁的重要原因。糖尿病引起的病理生理改变包括两个方面:一是血糖紊乱,二是神经内分泌的异常。胰岛素绝对或相对分泌不足是糖尿病患者糖代谢紊乱的根本原因。因此,给予外源性的胰岛素不仅纠正糖代谢紊乱,同时也可以纠正神经递质失调,促进神经细胞修复,阻断导致情绪紊乱的病理生理基础。而甲状腺功能是抑郁症发病及康复过程中重要的影响因素,甲状腺激素可能作为病因参与糖尿病的发病过程。本文通过对糖尿病患者胰岛素强化治疗前后抑郁的对比,胰岛素强化治疗者和口服降糖药治疗者抑郁情绪的对比及与血清甲状腺激素水平的相关性,探讨胰岛素强化治疗对糖尿病患者情绪的影响。方法:本研究应用抑郁自评量表,对入组的糖尿病患者入组时及胰岛素治疗三个月后进行抑郁情绪测定。并同时抽血送检甲状腺激素、FPG、2hPG、HbA1c。进行治疗前后的对比研究,并与口服降糖药治疗的对照组进行对比研究。治疗期间空腹血糖控制在4.4-6.1mmol/L,餐后2小时血糖控制在4.4-8.0mmol/L之间。采用t检验和秩和检验对数据进行统计。结果:胰岛素治疗前后抑郁程度差异显著(P < 0. 01),而口服降糖药组治疗前后无显著差异(P>0.05)。治疗前合并抑郁组T4、T3高于无抑郁组,TSH低于无抑郁组(P < 0. 01),治疗后两组T4、T3均下降,抑郁组较治疗前有显著差异,无抑郁组较治疗前无显著差异,抑郁组T4、T3仍高于无抑郁组,但两组间差异不显著,TSH略有下降,差异不显著。抑郁指数与T4、T3正相关,与TSH负相关;治疗后抑郁指数下降与T3、T4下降显著正相关(P < 0. 01)。结论:胰岛素强化治疗可以显著改善糖尿病患者的抑郁情绪,这种改变与甲状腺激素水平密切相关。
Objective The prevalence of comorbid depression people with type 2 diabetes mellitus(T2DM) is reportedly higher than in the general population. Some scholars think the change that lead to diabetes’pathophysiologic may be the important reason of depression. The outgrowth changes by diabetes included two side: one is disorder of blood glucose; the other is abnormality of neuroendocrine. Absolute or relative absence of insulin is the prime cause of diabetic glucose metabolism.So that, use insulin treatment not only rectify the glucose metabolism’s disorder, but asle correct neurotransmitters’abnormality,promote neurons outgrowth and stop the base of pathophysiological of emotion disorder. The article compares depression before intensive insulin treatment with after in T2DM, meanwhile compare depression after intensive insulin treatment with after oral antihyperglycemic agents and the relation with thyroid hormone level. To study impact of intensive insulin treatment on emotion in diabetes patients. Methods Self-Rating Depression Scale was used to screen depression in patients with T2DM right away and after intensive insulin treatment. We tested all patient’s thyroid hormone,FPG,2hPG,HbA1c at the same time. To compare befor treatment with after and to compare with oral antihyperglycemic agents. Fasting plasma glucose between 4.6 mmol/L and 6.1mmol/L, 2 hours postprandial glucose between 4.4 mmol/L and 8.0mmol/L. Data was count by t-test and rand sum test. Results Depression degree showed significantly difference befor and after insulin treatment(P<0.01), but oral antihyperglycemic agents showed no significantly difference befor and after treatment(P>0.05). T3,T4 were highter and TSH was lower in comorbid depression patients than no comorbid depression befor treatment (P<0.01). T3,T4 in both groups were reduced, depression groups showed significantly difference befor and after treatment,no depression groups showed no significantly difference befor and after treatment.TSH was reduced lightly, but showed no significantly difference. Depression index was negatively correlated with T3,T4, was positive correlation with TSH. A drop in depression index was positive correlation with T3,T4 (P<0.01).Conclusion Intensive insulin treatment could markedly improved depression status in diabetic patients and that was closely related with thyroid hormone level.
Objective The prevalence of comorbid depression people with type 2 diabetes mellitus(T2DM) is reportedly higher than in the general population. Some scholars think the change that lead to diabetes’pathophysiologic may be the important reason of depression. The outgrowth changes by diabetes included two side: one is disorder of blood glucose; the other is abnormality of neuroendocrine. Absolute or relative absence of insulin is the prime cause of diabetic glucose metabolism.So that, use insulin treatment not only rectify the glucose metabolism’s disorder, but asle correct neurotransmitters’abnormality,promote neurons outgrowth and stop the base of pathophysiological of emotion disorder. The article compares depression before intensive insulin treatment with after in T2DM, meanwhile compare depression after intensive insulin treatment with after oral antihyperglycemic agents and the relation with thyroid hormone level. To study impact of intensive insulin treatment on emotion in diabetes patients. Methods Self-Rating Depression Scale was used to screen depression in patients with T2DM right away and after intensive insulin treatment. We tested all patient’s thyroid hormone,FPG,2hPG,HbA1c at the same time. To compare befor treatment with after and to compare with oral antihyperglycemic agents. Fasting plasma glucose between 4.6 mmol/L and 6.1mmol/L, 2 hours postprandial glucose between 4.4 mmol/L and 8.0mmol/L. Data was count by t-test and rand sum test. Results Depression degree showed significantly difference befor and after insulin treatment(P<0.01), but oral antihyperglycemic agents showed no significantly difference befor and after treatment(P>0.05). T3,T4 were highter and TSH was lower in comorbid depression patients than no comorbid depression befor treatment (P<0.01). T3,T4 in both groups were reduced, depression groups showed significantly difference befor and after treatment,no depression groups showed no significantly difference befor and after treatment.TSH was reduced lightly, but showed no significantly difference. Depression index was negatively correlated with T3,T4, was positive correlation with TSH. A drop in depression index was positive correlation with T3,T4 (P<0.01).Conclusion Intensive insulin treatment could markedly improved depression status in diabetic patients and that was closely related with thyroid hormone level.
引文
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8 Tun PA,Nathan DM,Perlmuter LC. Cognitive and affective disorders in elderly diabetics[J].Clin Geriater med,1990,6: 731 -746.
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3 Okamura F,Tashiro A,Utumi A,et al.Insulin resistance in patients with depression and its changes during the clinical course of depression.Minimalmodle analysis[J].Metablism,2000,49(10) : 1255.
4 Egede LE,Zheng D,Simpson K.Comorbid depression is assoc- iated with increased health care use ane expenditures in Indivi- duals with diabetes. Diabetes Care,2002,25(3):464-470.
5 Anderson RJ,Freedland KE,Clouse RE,et al. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Dia- betes Care,2001,24(6):1069-1078.
6 Egede LE,Zheng D.Independent factors associated with major depressive disorder in a national sample of individuals with diabetes.Diabetes Care,2003,26(1):104-111.
7 袁勇贵.抑郁症和糖尿病的相关性研究[J]临床精神医学杂志,2004,14 (6) :371-372.
8 Tun PA,Nathan DM,Perlmuter LC. Cognitive and affective disorders in elderly diabetics[J].Clin Geriater med,1990,6: 731 -746.
9 姚静.糖尿病患者中的抑郁问题[J].国外医学精神病学分册,2001,28:199-203.
10 钱荣立,项坤三,刘力生,等.主编.中国糖尿病防治指南[M].天津:北京大学医学出版社,2004.24、58-60.
11 赵真.2型糖尿病 [J].临床和实验医学杂志,2006,5(5):512-514患者常见心理障碍患病情况的调查.
12 张彩霞,叶晓青,邓雪清,等.2型糖尿病患者焦虑抑郁情绪与社会心理因素的关系[J].中国心理卫生杂志,2006,20(6):374 -375、391.
13 强桂芬,崔景秋,孙津红.糖尿病与抑郁症[J].国外医学内分泌学分册,2001,21(3):118-121.
14 Arborelius L,Owens MJ,Plotsky PM. The role of corticotrophin- releasing factor in depression and anxiety disorders[J].J Endocrinol, 1999,160(1):1-12.
15 Raadsheer FC,Hoogendijk WJ,Stam FC,et al. Increased numbers of corticotropin-releasing hormone expressing neurons in the hypothalamic paraventricular pressed patients[J]. Neuroendo- crinology,1994,60(4):436-444.
16 屈娅,冯正直.下丘脑-垂体-肾上腺轴在抑郁症发病中的作用[J].局解手术学杂志,2004,13(1):58-60.
17 李鹤辰,贾福军. 甲状腺激素与抑郁症研究进展[J].国外医学精神病学分册,2003,30 (1) :21-24.
18 符少剑. 甲状腺功能障碍与难治性抑郁症[J].国外医学精神病学分册,1994,21: 40-43.
19 王大会,洪莉.糖尿病急性代谢紊乱患者的正常甲状腺病态综合征临床分析[J].现代中西医结合杂志,2007,16(1):32-33.
20 刘蕴玲,陈少华,杨华杰.抑郁情绪对2型糖尿病患者胰岛素敏感性的影响[J].山东精神医学,2005;18(1):13-15.
21 肖园园,李竞.初诊2型糖尿病患者胰岛β细胞功能观察[J].临床内科杂志,2006;23(1):38-40.
22 许晶,马丽珍,王俊平. 抑郁症的神经生物学研究[J].临床精神医学杂志,2003 ;13 (3):129 - 130.
23 何舒,林渝峰,李霞.抑郁症的发病机制研究进展[J]. 四川生理科学杂志2006;28(3):126-128.
24 高北陵.糖尿病时的大脑功能[J].国外医学精神病学分册,1996,23(3):139-143.
25 许晶,马丽珍,王俊平. 抑郁症患者血小板蛋白激酶C水平的变化[J]. 临床精神医学杂志,2003;13 (5):258 - 259.
26 郝一文,李亚明,周勇. 葡萄糖对内皮细胞蛋白激酶C 活性、通透性及粘附性的影响[J].中华核医学杂志,2005;25(2):113-115.
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