Objective To investigate 24-hour blood glucose profile and blood glucose fluctuation following peritoneal exchange in patients with end stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) with glucose-based peritoneal dialysis solution.Methods A total of 28 patients receiving CAPD due to ESRD were enrolled,of whom 15 subjects with diabetic nephropathy (DN group) and 13 were free of diabetes (NDN group).Data of 12 healthy volunteers (control group) was also analyzed.Patients of three groups were evaluated by continuous glucose monitoring systems (CGMS) and the parameters were measured.Results ＞ 11.1 percentage of time (PT) was higher in NDN group than that in control group (1％ (0-5％) vs 0) (P ＜ 0.05).There were no significant difference of ＞ 7.8 area under curve (AUC),＞ 11.1 AUC,standard deviation of blood glucose (SDBG),maximum glucose (MAX) and large amplitude of glycogenic excursion(LAGE) (P value between 0.056 and 0.094).Compared to healthy volunteers group,patients in DN group presented higher CGMS parameters.Patients in DN group also presented higher mean blood glucose(MBG),24-hour AUC,BG during peritoneal exchange(PE) and MAX after PE,compared with NDN group((9.4 ± 2.5) vs (6.4 ± 1.3) mmol/L,(7.0 ± 2.7) vs (4.2 ± 1.3)mmol · L-1 · d-1,(8.6 ±2.8) vs (6.2 ± 1.4) mmol/L,(11.5 ±2.6) vs (8.5 ±2.4) mmol/L,all P ＜0.05).Patients with DN and HbA1c ＜7％ also displayed higher MBG,24-hour AUC,＞7.8AUC and ＞7.8PT,＞ 11.1 PT and MAX after PE than NDN group(t ＝ 1.808-3.627,all P ＜0.05).Hypoglycemia events occurring at night in DN group was higher than that in NDN group and control group.There was no significant difference of the impact on blood glucose level with the use of 1.5％ or 2.5％ peritoneal solution in the diabetic nephropathy patients group (all P ＞ 0.05).Conclusion Continuous ambulatory peritoneal dialysis with glucose-based peritoneal dialysis solution may impose disturbance to glucose homeostasis in patients with ESRD,with a more significant impact in those with diabetic nephropathy.%目的 研究持续性非卧床腹膜透析(CAPD)患者全天血糖谱的变化规律.方法 选取2009年4月至2011年12月在中山大学附属第一医院腹膜透析中心行腹膜透析的终末期肾病患者28例,其中15例为2型糖尿病肾病患者(DN组),13例为非糖尿病肾病患者(NDN组).另设健康对照组12名,为同期来我院门诊体格检查各项指标均正常者.应用动态血糖监测系统(CGMS)对3组进行连续72 h的动态血糖监测,分析各组动态血糖参数特点.用多元协方差分析控制组间基线差异,并处理血红蛋白对HbA1c的影响效应.结果 与正常对照组相比,NDN组＞11.1 mmol/L血糖百分比(PT)明显高于正常对照组,差异有统计学意义[(1％(0～5％)比0,P ＜0.05],且＞7.8 mmol/L曲线下面积(AUC)、＞11.IAUC、平均血糖水平的标准差(SDBG)、血糖最大值(MAX)、日内最大血糖波动幅度(LAGE)均有升高趋势(P值介于0.056 ～0.094).而DN组上述指标则更高.此外DN组平均血糖水平(MBG)、24 h AUC、透析相关指标如腹膜透析时血糖、透析后MAX也明显高于NDN组[(9.4±2.5)比(6.4± 1.3) mmol/L,(7.0±2.7)比(4.2±1.3) mmol·L-1·d-1,透析时血糖(8.6±2.8)比(6.2±1.4) mmol/L,透析后MAX(11.5±2.6)比(8.5±2.4) mmol/L](均P＜0.05).糖化血红蛋白＜7％的DN组患者的血糖指标如MBG、24 h AUC、＞7.8AUC及PT、＞11.1PT,腹膜透析相关指标如透析后MAX也较NDN组显著升高(t值为1.808 ～3.627,均P＜0.05).DN组的夜间低血糖检出率明显高于NDN组及正常对照组.在DN患者中,使用2.5％葡萄糖透析液与1.5％透析液的患者相比,各项血糖指标均有升高趋势(均P＞0.05).结论 CAPD时葡萄糖腹膜透析液可影响患者的血糖稳态,对DN患者的影响更为明显.
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