Impacts Of Stress On Blood Glucose And Relaetd Hormones In Non-diabetic Patients

Background： When encounter severe trauma, infection, bleeding, pain orsurgery and stress reaction, diabetes patients will suffer diffcult to control the conductof hyperglycemia, even appear acute complications of diabetes ketoaeidosis andhyperosmolar hyperglycemic coma, seriously affect the prognosis of the disease.While in Non-diabetic patients,the original sugar metabolic balance will disorder tooand produce acute blood glucose. Previous studies have shown that infection rates andmortality of patients fold increase with stress hyperglycemia, stress hyperglycemiahas become the impact on the disease prognosis independent factors. Clear the extentand causes of stress hyperglycemia, to guide treatment, improve survival and improvethe prognosis of great significance. The purpose of this study is to further clarify thedegree of hyperglycemia after stress and related neuroendocrine hormones change, toexplore the clinical significance of the treatment.Objects: Observed clinical suffered acute stress （simple fractures,combinedinjuries, cerebral hemorrhage, acute myocardial infarction） patients on admissionblood glucose, insulin, C-peptide, cortisol, epinephrine, norepinephrine glucose,thyroid hormones and related neuroendocrine indicators level to explore the degree ofchanges in blood sugar and body suffered stress-related causes.Methods: Collecting33cases of patients suffered stress （Including fracturetrauma,combined injuries, cerebral hemorrhage, acute myocardial infarction） andCollecting healthy control group of30cases.Detecting each group fastingglucose（FG）, fasting plasma insulin（FI）, C-peptide, adrenaline（A）, norepinephrine（NE）, cortisol and thyroid hormones levels; and calculating HOMA_IRwith FG and FIof each group.Result：①The level of fasting glucose in stress group was higher than the normal control group, and there was significant difference（P<0.01）.②The fastingplasma insulin, C peptide and HOMA_IRof stress group were higher than the normalcontrol group respectively, and there were significant difference（P<0.01）.③Thelevels of adrenaline（A）, norepinephrine（NE）, cortisol in stress group were higher thanthe normal control group respectively, and there were significant difference（P<0.05;P<0.01）.④The level of FT3in stress group was lower than the normal controlgroup, and there was significant difference（P<0.01）, but the levels of FT4and TSHshowed no change（P>0.05）.⑤There was significant positive correlation betweenFBG and HOMA_IR（r=0.732; P<0.01）; while there was significant negativecorrelation between FT3and HOMA_IR（r=-0.579; P<0.01）.Conclusion: The level of fasting glucose in patients suffered severe stress wasmuch higher than the normal persons. While the common hormone in stress such asadrenaline（A）, norepinephrine（NE）, cortisol and fasting insulin, C peptide weresignificantly higher. HOMA_IRin patients suffered severe stress was much higher thanthe normal persons, which was calculated with fasting glucose and fasting plasmainsulin. According to the study, there were maybe two reasons of hyperglycemia, onewas activation of Neuroendocrine system and increase in hormone release; the otherone was insulin resistance（IR）.At the same time, The thyroid hormones, especiallyFT3, in patients suffered severe stress was much lower than the normal persons; andthe level of FT3had a negetive correlation with HOMA_IR. We can monitor someindicators such as the blood glucose, thyroid hormones and IR index to assess thecondition and evaluate the prognosis of stress patients.