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心理应激对 型糖尿病人糖代谢影响的对照研究 |
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王丽 薛志敏 姚树桥 戴晓阳 周智广 毛季平
中图分类号：R395.1 文献标识码：A
文章编号：1005-3611(2000)02-0098-02
Psychological Stress and Glycemic Metabolism in NIDDM
WANG Li,XUE Zhimin,YAO Shuqiao et al
Hunan Medical University,Changsha
Objective: To explore the effects of psychological stress on glycemic metabolism in non-insulin-dependent diabetes mellitus(NIDDM). Methods: 37 subjects with NIDDM were randomly divided into experimental and control groups. Psychological stress was induced in the experimental group by way of showing a video concerning adverse symptoms of severe diabetes. Measures of plasma glucose, plasma insulin, blood pressure, pulse rate and state anxiety were assessed at 0, 30, 60, 120 and 180 min during oral glucose tolerance testing (OGTT). Results: The overall levels of state anxiety were significantly higher in the experimental group than in the control group (p<0.05). Significantly higher levels of change in pulse rate and blood pressure from their baselines were found in the experimental group (p<0.001). Despite similar baseline plasma glucose levels, subjects in the experimental group showed higher levels of plasma glucose at 30 and 60 min (p<0.05) when compared to controls. Conclusion: Psychological stress produced significant effects on glycemic metabolism in NIDDM.
Key words: Psychological stress, NIDDM, Glycemic metabolism
应激与Ⅱ型糖尿病人糖代谢之间的关系研究已经进行多年，尤其近十五年有了相当多的文献报道。如Grant等研究发现急性生活事件尤其是急性负性生活事件与糖尿病人症状的加重有关。McClesky等发现糖尿病人表现出对手术应激的高血糖反应。但Naliboff Cohem等人的研究结果显示尽管躯体性应激(姿势限制、夹手)和心理性应激(心算)使血浆儿茶酚胺水平升高，但两组病人的血糖水平并无显著改变［1］。可见，应激对糖尿病人糖代谢的影响尚未能得出一确切的结论。以往的研究大多缺乏糖尿病人的对照组，而且研究的结果易受病情、饮食控制及药物治疗的影响，所以本研究以初发的、未经饮食控制及药物治疗的Ⅱ型糖尿病人为研究对象，探讨心理性应激对Ⅱ型糖尿病人口服葡萄糖耐量试验(OGTT)五点血糖、血浆胰岛素的影响。
1 对象与方法
1.1 研究对象
病例全部来自1997年4月至1997年12月间来湖南医科大学附属第二医院内分泌门诊就诊的病人。入选标准：初发、未经饮食控制且未服用任何控制血糖药物的Ⅱ型糖尿病人，符合1985年WHO糖尿病专家委员会制订的糖尿病诊断标准［6］，无酮症酸中毒、阳痿、严重心脏疾病，不伴有内分泌系统其他疾病，女性为非妊[1] [2] [3] 下一页
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