血糖波动在慢性肾脏病患者的发生意义及相关因素研究

摘要

目的：研究血糖波动在慢性肾脏病患者的发生意义及与肾脏病临床指标的相关性。方法：选择近1年在我院住院患者88例,使用MDRD公式计算eGFR,将患者分为3组：A(eGFR≥60 ml·min-1·1.73 m-2)、B(eGFR为30~60 ml· min-1·1.73 m-2)、C(eGFR≤30 ml·min-1·1.73 m-2)组,所有患者均采用动态血糖检测系统连续监测48 h血糖,计算血糖波动系数、高血糖(>7.8 mmol/L)时间比、高血糖(>11.1 mmol/L)、低血糖(<3.9 mmol/L)时间比、空腹血糖平均值及餐后2 h葡萄糖,并记录一般临床资料：身高、体重、血压；检测血生化、胰岛素抵抗( insulin resistance,IR)相关指标、糖化血红蛋白、24 h尿蛋白定量、甲状旁腺激素,计算身高体重指数、估算肾小球滤过率( estimated glomerular filtration rate,eGFR)及胰岛素抵抗( HOMR-IR)指数。采用pearson相关分析、sperman相关分析及多元逐步回归分析变量间关系。排除近6个月使用激素患者、有糖尿病患者及糖尿病家族史患者。结果：B组及C组血糖波动系数及血糖>11.1 mmol/L时间比明显大于A组(P<0.05),B、C组间差异无统计学意义。 B组午餐后2 h血糖平均值大于A组,而在低血糖时间比上各组之间差异无统计学意义。结论：慢性肾衰竭中晚期患者易出现血糖的异常波动,主要表现为波动性高血糖,尤其餐后明显,临床上需关注,动态血糖监测技术有助于对CKD患者血糖波动细节的监测。%Objective:To investigate the relation between glucose fluctuations and CKD ( chronic kidney disease) ,explore the potential correlation between laboratory parameters in CKD patients and analyze the correlated factors of glucose fluctuations. Methods:88 patients with CKD were selected, divided them into three groups according the MDRD eGFR:A( eGFR≥60 ml·min-1 · 1. 73 m-2),B(eGFR of 30~60 ml·min-1·1. 73 m-2), C (eGFR≤30 ml·min-1·1. 73 m-2)group. The BGFC(blood glucose fluctuation coefficient),time rate of hyperglycemia( >7. 8 mmol/L), time rate of hyperglycemia ( >11. 1 mmol/L), time rate of hy-poglycemia( <3. 9 mmol/L),mean fasting glucose and 2-hour postprandial glucose were calculated according the results of CGMS ( Continuous Glucose Monitoring System) . Clinical data including general indicators ( height, weight, blood pressure) ,blood chemis-try,IR ( insulin resistance) related indicators , glycosylated hemoglobin,24-hour urinary protein excretion , PTH ( Parathyroid hor-mone) , BMI ( body mass index) ,eGFR ( estimated glomerular filtration rate) . We used multiple regression analysis to test for correla-ted factors of glucose fluctuations in CKD patients. Results:Compared with A group, the BGFC and the time rate of hyperglycemia (11. 1 mmol/L) are greater in group B and C (P<0. 05), there is no statistically significant difference between B and C. The mean 2-hour postprandial( lunch) in B is significantly greater than A group, there is no significant difference in time rata of hypoglycemia ( <3. 9 mmol/L)among these groups . Conclusion:Advanced CKD patients prone to abnormal glucose fluctuations,lead to bad clini-cal results, early diagnosis and intervention is necessary. CGMS is a appropriate way to observe the glucose fluctuations in CKD.