Wang Liang, Meng Xiaomei, Tang Yuxiao, Hao Yaping
Department of Endocrinology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Front Endocrinol (Lausanne). 2025 Jan 31;16:1418357. doi: 10.3389/fendo.2025.1418357. eCollection 2025.
In the early stages of various critical infections and diseases, altered association of cortisol and adrenocorticotropic hormone (ACTH) levels occurs, with cortisol levels increasing and ACTH levels remaining normal or decreasing. This study aimed to explore the relationship between ACTH and cortisol levels in patients with diabetic ketoacidosis (DKA) and the influence of the severity of DKA.
A total of 106 type 2 diabetes patients with DKA admitted to the Endocrinology Department of Yantai Yuhuangding Hospital from February 2018 to May 2023 were divided into groups without (n=54) and with bacterial infection (n=52). Twenty type 2 diabetes patients without infection or DKA admitted during the same period were included as the control group. Cortisol and ACTH levels were measured on the first day of admission and the day after DKA correction for patients with DKA and on the first day of admission and the day before discharge for the control group.
Compared with the control group, the DKA groups both with and without infection had significantly higher cortisol levels (<0.05) and significantly lower ACTH levels (<0.01) at admission. DKA patients with infection had significantly higher cortisol levels at admission than those without infection (734.51 ± 348.69 nmol/L vs 508.79 ± 268.72 nmol/L, <0.01), while ACTH levels did not differ significantly between the two groups (>0.05). After correction of DKA, no differences in cortisol or ACTH levels were observed among the three groups. Compared with levels at admission, DKA patients both with and without infection had lower cortisol levels and higher ACTH levels after DKA correction (all <0.001). Multiple stepwise regression analysis showed that for all DKA patients and for subgroups with and without infection, the cortisol level at admission was independently positively correlated with the ACTH level and negatively correlated with the bicarbonate level (both <0.01).
In the early stage of DKA, a phenomenon of altered association between cortisol-ACTH occurs and is especially prominent in DKA patients with infection. This altered association between cortisol-ACTH disappears after DKA correction, and the severity of DKA is an independent influencing factor on the cortisol level in early-stage DKA.
在各种严重感染和疾病的早期阶段，皮质醇和促肾上腺皮质激素（ACTH）水平的关联会发生改变，皮质醇水平升高而ACTH水平保持正常或下降。本研究旨在探讨糖尿病酮症酸中毒（DKA）患者中ACTH与皮质醇水平之间的关系以及DKA严重程度的影响。
选取2018年2月至2023年5月期间入住烟台毓璜顶医院内分泌科的106例2型糖尿病DKA患者，分为无细菌感染组（n = 54）和有细菌感染组（n = 52）。同期选取20例无感染或DKA的2型糖尿病患者作为对照组。对DKA患者在入院首日及DKA纠正后次日测量皮质醇和ACTH水平，对对照组在入院首日及出院前一日测量。
与对照组相比，有感染和无感染的DKA组入院时皮质醇水平均显著升高（<0.05），ACTH水平均显著降低（<0.01）。有感染的DKA患者入院时皮质醇水平显著高于无感染患者（734.51±348.69 nmol/L对508.79±268.72 nmol/L，<0.01），而两组间ACTH水平差异无统计学意义（>0.05）。DKA纠正后，三组间皮质醇或ACTH水平无差异。与入院时相比，有感染和无感染的DKA患者DKA纠正后皮质醇水平降低，ACTH水平升高（均<0.001）。多元逐步回归分析显示，对于所有DKA患者以及有感染和无感染的亚组，入院时皮质醇水平与ACTH水平呈独立正相关，与碳酸氢盐水平呈负相关（均<0.01）。
在DKA早期，存在皮质醇 - ACTH关联改变的现象，在有感染的DKA患者中尤为突出。DKA纠正后，这种皮质醇 - ACTH关联改变消失，且DKA的严重程度是早期DKA患者皮质醇水平的独立影响因素。
