【摘要】：目的:高血糖高滲狀態(tài)和糖尿病酮癥酸中毒時(shí)可出現(xiàn)血糖、血鈉增高,可同時(shí)伴有血皮質(zhì)醇水平的升高,易誤診為皮質(zhì)醇增多癥。通過對(duì)這兩種糖尿病急癥血皮質(zhì)醇的變化趨勢(shì)的動(dòng)態(tài)觀察,與皮質(zhì)醇增多癥時(shí)血皮質(zhì)醇變化特點(diǎn)的進(jìn)行分析比較,結(jié)合治療后血糖、血鈉的變化特點(diǎn),與皮質(zhì)醇增多癥相互鑒別,為臨床上進(jìn)行鑒別診斷提供參考依據(jù)。方法:隨機(jī)選取2型糖尿病無急性并發(fā)癥患者40例,伴有糖尿病酮癥酸中毒或高血糖高滲狀態(tài)患者38例(其中血鈉增高組18例,血鈉正常組20例),分別測(cè)定8時(shí)、16時(shí)、24時(shí)血皮質(zhì)醇(Cor)、空腹血糖(FBG)、空腹C肽、餐后2小時(shí)C肽、血鈉的水平。并于治療2周后復(fù)查上述結(jié)果,進(jìn)行對(duì)比分析。1個(gè)月后隨診2型糖尿病急癥組血皮質(zhì)醇水平。結(jié)果:2型糖尿病無急癥組各時(shí)段血皮質(zhì)醇均正常。2型糖尿病伴急癥組8時(shí)、16時(shí)、24時(shí)血皮質(zhì)醇高于無急癥組,差距有統(tǒng)計(jì)學(xué)意義(P0.05),但節(jié)律正常;2型糖尿病急癥血鈉增高組同血鈉正常組比較8時(shí)、16時(shí)、24時(shí)血皮質(zhì)醇無明顯差別(P0.05)。2型糖尿病急癥組治療后血鈉恢復(fù)正常水平,空腹血糖,血皮質(zhì)醇較前明顯下降,差距有統(tǒng)計(jì)學(xué)意義(P0.05)。1個(gè)月后隨診2型糖尿病急癥組血皮質(zhì)醇均恢復(fù)正常。結(jié)論:高血糖高滲狀態(tài)和糖尿病酮癥酸中毒時(shí)各時(shí)段血皮質(zhì)醇均明顯升高,但血皮質(zhì)醇節(jié)律正常,治療后血鈉恢復(fù)正常,血皮質(zhì)醇、空腹血糖較前明顯下降,可與皮質(zhì)醇增多癥血皮質(zhì)醇節(jié)律異常相鑒別。
[Abstract]:Objective: hyperglycemia and diabetic ketoacidosis may occur with increased blood glucose and sodium, and may be accompanied by an increase in serum cortisol level, which is liable to be misdiagnosed as cortisol hyperthermia. Through the dynamic observation of the change trend of serum cortisol in these two kinds of diabetes emergency, the characteristics of changes of blood cortisol in patients with cortisol were analyzed and compared, and the changes of blood glucose and sodium were combined with the changes of blood glucose and sodium after treatment. It can provide reference for clinical differential diagnosis of polycortisol syndrome. Methods: forty patients with type 2 diabetes without acute complications and 38 patients with diabetic ketoacidosis or hyperglycemia were randomly selected. 24:00 serum cortisol (Cor), fasting blood glucose (FBG), fasting C peptide, 2 hour postprandial C peptide, blood sodium level. After 2 weeks of treatment, the above results were compared and analyzed. 1 month after follow-up, the serum cortisol level in type 2 diabetes emergency group was followed up. Results: the level of cortisol was normal in type 2 diabetes mellitus without emergency group. The level of cortisol in type 2 diabetes with emergency group was higher than that in type 2 diabetes mellitus without emergency group at 8, 16:00 and 24:00, the difference was statistically significant (P0.05), but the rhythm was normal. There was no significant difference in serum cortisol between the type 2 diabetes emergency group and the normal group (P 0.05). The blood sodium returned to normal level and fasting blood glucose in the type 2 diabetes emergency group after treatment. Blood cortisol significantly decreased compared with the former, the difference was statistically significant (P0.05). 1 month after follow-up of type 2 diabetes emergency group blood cortisol returned to normal. Conclusion: in hyperglycemic hyperosmotic state and diabetic ketoacidosis, serum cortisol was significantly increased, but the rhythm of serum cortisol was normal, blood sodium returned to normal, blood cortisol and fasting blood glucose decreased significantly after treatment. It can be distinguished from abnormal rhythm of cortisol in patients with polycortisol.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R587.2

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