PSYCHOLOGICAL STRESS AND METABOLIC CONTROL IN PATIENTS WITH TYPE-I DIABETES-MELLITUS
PSYCHOLOGICAL STRESS AND METABOLIC CONTROL IN PATIENTS WITH TYPE-I DIABETES-MELLITUS
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DOI：
10.1056/nejm198604243141704
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发表时间：
1986-04-24
影响因子：
158.5
通讯作者：
BERGER, M
中科院分区：
文献类型：
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作者：
KEMMER, FW;BISPING, R;BERGER, M
急性心理应激被认为会导致I型糖尿病患者代谢控制紊乱。为了检验这一假设的有效性，我们对9名健康人（平均[.+-]）进行了研究。[SEM]血糖，74 .+-。2毫克/分升)，9例1型糖尿病患者血糖正常(130。10毫克/分升)，9例糖尿病患者伴有高血糖(444 .+-。17毫克/分升)导致两种急性心理压力：心算和公众演讲。三组受试者的年龄、体重、性别和社会经济地位相匹配。所有受试者在做心算时心率平均增加20次/分钟，在公开演讲时心率平均增加25次/分钟（P < 0.001）。在所有三组中，在两种应激条件下，收缩压和舒张压均显著升高，血浆肾上腺素水平升高50 ~ 150 pg /毫升，去甲肾上腺素水平升高100 ~ 200 pg /毫升（P < 0.001）。在公开演讲后，所有小组的血浆皮质醇水平都显著上升。两种应激均未引起葡萄糖、酮类、游离脂肪酸、胰高血糖素或生长激素循环水平的变化。因此，突然的、短暂的心理刺激引起明显的心血管反应和血浆儿茶酚胺和皮质醇浓度的适度升高，不太可能干扰I型糖尿病患者的代谢控制。
Acute psychological stress is believed to cause disturbances of metabolic control in patients with Type I diabetes. To examine the validity of this assumption, we subjected nine healthy persons (mean [ .+-. SEM] blood glucose level, 74 .+-. 2 mg per deciliter), nine patients with Type I diabetes who had normoglycemia (130 .+-. 10 mg per deciliter), and nine diabetic patients with hyperglycemia (444 .+-. 17 mg per deciliter) to two acute psychological stresses: mental arithmetic and public speaking. Subjects in the three groups were matched for age, weight sex, and socioeconomic status. For all subjects, the mean increase in heart rate was 20 beast per minute while they were doing mental arithmetic and 25 beats per minute while they were speaking publicly (P < 0.001). In all three groups, systolic and diastoic pressure rose markedly, the plasma epinephrine level increased by 50 to 150 pg per millilter, and the norepinephrine level by 100 to 200 pg per milliter under both stress conditions (P < 0.001). The plasma cortisol level rose significantly after public speaking in all groups. Neither stress induced changes in circulating levels of glucose, ketones, free fatty acids, glucagon, or growth hormone. Thus, sudden, short-lived psychological stimuli causing marked cardiovascular responses and moderate elevations in plasma concentrations of catecholamines and cortisol are unlikely to disturb metabolic control in patients with Type I diabetes.