糖尿病患者应用糖皮质激素后24 h血糖波动监测的意义

摘要

目的 观察2型糖尿病患者实施不同类型糖皮质激素治疗后的24 h血糖波动特点,为2型糖尿病患者出现的高血糖进行早期监测和进一步治疗提供依据.方法 选取2014年3月至2016年3月来我院皮肤科、内分泌科、风湿免疫科、血液病科就诊的糖尿病患者共60例,所有入选患者均接受糖皮质激素治疗,按治疗方式的不同分为三组,每组各20例.其中DM1组静滴甲强龙40 mg,DM2组静滴地塞米松10 mg,DM3组一次口服强的松30 mg;所有患者均连续治疗6 d.对三组患者分别行3 d动态血糖监测,比较其日间血糖平均绝对差(MODD)、日内平均血糖波动幅度(MAGE)、全天血糖标准差(SDBG)、平均餐后血糖波动幅度(MPPGE)等动态血糖参数的变化.同时在患者行3 d动态血糖监测的第2天清晨采集患者空腹静脉血,监测其血清中糖化血红蛋白(HbA1c).同时,比较三组患者的血糖漂移情况,包括低血糖时间比率、高血糖时间比率、血糖波动系数.结果 DM2组患者的HbA1c、MAGE、SDBG、MPPGE水平均高于DM3组和DM1组,而DM3组的HbA1c、MAGE、SDBG、MPPGE水平均高于DM1组,差异均有显著统计学意义(P<0.01),但三组患者的MODD水平比较差异无统计学意义(P>0.05);DM1组患者的高血糖时间比率为(17.35±4.27)%,血糖波动系数为(2.52±1.22);DM2组患者的高血糖时间比率为(26.30±6.30)%,血糖波动系数为(3.98±1.57);DM3组患者的高血糖时间比率(20.29±4.03)%、血糖波动系数(3.31±1.17);由此可知DM2组患者的高血糖时间比率、血糖波动系数显著高于DM1组及DM3组,差异均有统计学意义(P<0.05).DM1组、DM2组、DM3组三组患者的低血糖时间比率分别为(2.60±1.42)%、(6.61±2.07)%、(3.87±1.92)%,故低血糖时间比率由低到高依次为DM1组、DM3组、DM2组,其中DM2组患者的低血糖时间比率最高,各组间比较差异均有统计学意义(P<0.05).结论 应用糖皮质激素治疗糖尿病患者除全程常规监测HbA1c外,还应动态监测血糖,以便制定个体化治疗方案.%Objective To observe the characteristics of 24 h blood glucose fluctuation in patients with type 2 diabetes mellitus after undergoing different types of glucocorticoid therapy, so as to provide basis for early detection and further treatment of high blood glucose in patients with type 2 diabetes. Methods A total of 60 diabetic patients treated with glucocorticoid in Department of Dermatology, Endocrinology, Rheumatology and Hematology in First Affiliated Hospital of Hebei North University from March 2014 to March 2016 were divided into three groups, 20 cases in each group, according to the different treatment methods. The patients in the DM1 group was given methylprednisolone 40 mg, dexamethasone 10 mg in DM2 group, and prednisone 30 mg in DM3 group. All the patients were continuously treated for 6 days. The 3 d continuous glucose monitoring were performed respectively in the three groups to detect the glucose parameters,such as absolute means of daily difference (MODD), mean amplitude of glycemic excursions (MAGE), stan-dard deviation of blood glucose (SDBG) of one day, and mean postprandial glucose excursion (MPPGE). Glycosylated hemoglobin (HbA1c) was detected on the second day of the 3 d continuous glucose monitoring. And blood sugar drift in-cluding hypoglycemia time ratio, high blood sugar ratio and blood sugar fluctuation coefficient in the patients among three groups were compared. Results The HbA1c, MAGE, SDBG, and MPPGE levels of the patients in DM2 group were higher than those in DM3 group and DM1 group, and HbA1c, MAGE, SDBG, MPPGE levels of patients in the DM3 group were higher than those in DM1 group, demonstrating statistically significant differences (P<0.01). No signif-icant difference in the MODD levels among the three groups was found (P>0.05). The time ratio of high blood sugar of patients in the DM1 group was (17.35±4.27)%, and blood glucose fluctuation coefficient was (2.52±1.22), which were(26.30±6.30)% and (3.98±1.57) in DM2 group, (20.29±4.03)% and (3.31±1.17) in DM3 group. Therefore, time ratio ofhigh blood sugar and fluctuation coefficient of blood sugar of patients in DM2 group were significantly higher than thosein DM1 group and DM3 group (P<0.05). Time ratio of low blood glucose in DM1 group, DM2 group and DM3 groupwere (2.60±1.42)%, (6.61±2.07)% and (3.87±1.92)%, which was the highest in DM2 group, with statistically significantdifferences among the three groups (P<0.05). Conclusion Dynamic monitoring of blood glucose as well as the routinemonitoring of HbA1c should be conducted in diabetic patients with glucocorticoid treatment in order to develop individualizedtreatment.