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目的研究焦虑障碍与2型糖尿病(T2DM)患者胰岛素抵抗之间的关系,及心理干预对胰岛素抵抗的影响。方法对T2DM患者及健康人群进行焦虑状态/特质询问表(STAI)测试,分别选取基线资料匹配的有、无焦虑障碍T2DM患者52例和54例作为研究对象。所有对象均检测空腹血糖、空腹胰岛素、皮质醇(CRO)、白细胞介素6(IL-6)水平并计算胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HBCI)及胰岛素分泌功能指数(IS)。对焦虑障碍患者进行心理干预4～6周,再次行STAI测试并重复上述生化指标检查。结果焦虑障碍T2DM患者血清IL-6、CRO及HOMA-IR等指标明显高于无焦虑障碍患者(P均<0.01),HBCI及IS明显低于无焦虑障碍患者(P均<0.01);心理干预4～6周后状态焦虑阳性率明显下降(P<0.01),特质焦虑阳性率下降不明显(P>0.05);焦虑障碍改善明显患者的CRO、IL-6、HOMA-IR的下降及HBCI、IS的升高亦明显(P均<0.01)。结论焦虑障碍与T2DM患者胰岛素抵抗密切相关;心理治疗有助于减轻焦虑障碍、改善胰岛素抵抗。
Objective To investigate the relationship between anxiety disorders and insulin resistance in type 2 diabetes mellitus (T2DM) and the effect of psychological intervention on insulin resistance. Methods The anxiety state / trait query (STAI) test was performed on T2DM patients and healthy subjects. Fifty-two and 54 patients with T2DM without or with anxiety disorder and matched baseline data were selected as the study subjects. Fasting blood glucose, fasting insulin, cortisol (CRO) and interleukin 6 (IL-6) levels were measured in all the subjects. HOMA-IR, HBCI and insulin secretion index IS). Psychological intervention for patients with anxiety disorders 4 to 6 weeks, again STAI test and repeat the biochemical tests. Results The serum levels of IL-6, CRO and HOMA-IR in T2DM patients with anxiety disorders were significantly higher than those without anxiety disorders (P <0.01), HBCI and IS were significantly lower than those without anxiety disorders (P <0.01) After 4 to 6 weeks, the positive rate of state anxiety decreased significantly (P <0.01), but the positive rate of trait anxiety did not decrease significantly (P> 0.05). The decline of CRO, IL-6 and HOMA- IS was also significantly higher (all P <0.01). Conclusions Anxiety disorder is closely related to insulin resistance in T2DM patients. Psychotherapy can relieve anxiety disorder and improve insulin resistance.