Dutour A, Boiteau V, Dadoun F, Feissel A, Atlan C, Oliver C
Service d'Endocrinologie, Maladies Métaboliques et Nutrition, Institut Fédératif Jean Roche, Hôpital Nord, Marseille, France.
Psychoneuroendocrinology. 1996 Aug;21(6):525-43. doi: 10.1016/s0306-4530(96)00014-5.
Acute psychological stress may play a role in the glycaemic instability of some patients with type I diabetes through an increased secretion of insulin-counteracting hormones. To examine the validity of this hypothesis, we subjected to a video-recorded public-speaking stress seven healthy persons, six type I diabetics with stable blood glucose levels and six type I diabetics with unstable or brittle diabetes (with more than 10 hypoglycaemia/month and frequent hyperglycaemia). During the test and on a control day, heart rate, blood pressure, plasma ACTH, cortisol, catecholamines and prolactin were measured. The comparison between the stable and unstable diabetics during the stress session by two-way analysis of variance (group/time) showed a significant difference for heart rate, blood pressure, ACTH and cortisol. Psychological interview showed that most unstable diabetics perceived a link between life stress and their blood glucose control. The unstable patients had much more difficulty in verbalizing their emotions. Our study shows that the two groups of diabetic patients display distinct cardiovascular and neuroendocrine responses to psychological stress, as well as distinct psychological profiles. In conclusion, hormonal response to an acute psychological stress is more pronounced in brittle diabetes and might be one of its pathogenic factors.
急性心理应激可能通过增加胰岛素拮抗激素的分泌，在一些1型糖尿病患者的血糖不稳定中起作用。为了检验这一假设的正确性，我们让7名健康人、6名血糖水平稳定的1型糖尿病患者和6名患有不稳定或脆性糖尿病（每月低血糖发作超过10次且频繁出现高血糖）的1型糖尿病患者，接受了一次视频记录的公开演讲应激测试。在测试期间和对照日，测量了心率、血压、血浆促肾上腺皮质激素（ACTH）、皮质醇、儿茶酚胺和催乳素。通过双向方差分析（组/时间）对稳定型和不稳定型糖尿病患者在应激期间的数据进行比较，结果显示心率、血压、ACTH和皮质醇存在显著差异。心理访谈表明，大多数不稳定型糖尿病患者认为生活应激与他们的血糖控制之间存在关联。不稳定型患者在表达自己的情绪方面困难得多。我们的研究表明，两组糖尿病患者对心理应激表现出不同的心血管和神经内分泌反应，以及不同的心理特征。总之，脆性糖尿病患者对急性心理应激的激素反应更为明显，这可能是其致病因素之一。
