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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-hour blood glucose fluctuation in patients with type 2 diabetes mellitus after being treated with different types of glucocorticoids for the purpose of providing the basis for early monitoring and further treatment of hyperglycemia in type 2 diabetic patients. Methods A total of 60 diabetics from March 2014 to March 2016 in our department of dermatology, endocrinology, rheumatology and hematology were enrolled in this study. All patients were enrolled in corticosteroid treatment. According to the different treatment methods Divided into three groups, each group of 20 cases. DM1 group intravenous methylprednisolone 40 mg, DM2 group intravenous dexamethasone 10 mg, DM3 group prednisone 30 mg; all patients were treated for 6 days. Three-day dynamic glucose monitoring was performed on the three groups. The mean daytime mean blood glucose (MODD), intraday average blood glucose (MAGE), standard deviation of the day (SDBG), average postprandial blood glucose fluctuation (MPPGE ) And other dynamic changes in blood glucose parameters. At the same time, fasting venous blood was collected on the second day of the third day of dynamic glucose monitoring in patients and the serum hemoglobin A1c (HbA1c) was monitored. At the same time, the three groups of patients were compared for their glycemic excursions, including hypoglycemic time, hyperglycemic time, and glycemic index. Results The levels of HbA1c, MAGE, SDBG and MPPGE in DM2 group were higher than those in DM3 and DM1 group. The levels of HbA1c, MAGE, SDBG and MPPGE in DM3 group were significantly higher than those in DM1 group (P < 0.01). However, there was no significant difference in the MODD levels among the three groups (P> 0.05). The DM1 group had a high rate of hyperglycemia (17.35 ± 4.27)% and a coefficient of fluctuation of 2.52 ± 1.22 The ratio of hyperglycemic time was (26.30 ± 6.30)%, the coefficient of fluctuation of blood glucose was (3.98 ± 1.57), the rate of hyperglycemia (20.29 ± 4.03)% and the coefficient of fluctuation of blood glucose (3.31 ± 1.17) in DM3 group It can be seen that DM2 group patients with high blood sugar time ratio, blood glucose fluctuation coefficient was significantly higher than DM1 group and DM3 group, the difference was statistically significant (P <0.05). The hypoglycemic time rates of the three groups were (2.60 ± 1.42)%, (6.61 ± 2.07)% and (3.87 ± 1.92)% respectively in DM1 group, DM2 group and DM3 group, so the hypoglycemic time ratio from low to high was DM1 group, DM3 group and DM2 group. The DM2 group had the highest rate of hypoglycemia, the difference between the two groups was statistically significant (P <0.05). Conclusion Glucocorticoid treatment of diabetic patients in addition to the routine monitoring of HbA1c, but also dynamic monitoring of blood glucose in order to develop individualized treatment options.