目的探讨使用碘造影剂前后停用二甲双胍对糖尿病患者血糖水平的影响。方法研究对象选自2012年1月1日至12月31日在北京大学第一医院住院的糖尿病患者,入选标准为使用含二甲双胍方案治疗后血糖水平基本达标并维持平稳、应用碘造影剂前后48 h内停用二甲双胍且有停药前后空腹、早餐后2 h、午餐后2 h、晚餐后2 h和睡前血糖水平监测记录。停用二甲双胍期间调整降糖治疗方案者纳入调整组,未调整治疗方案者纳入未调整组。收集2组患者的病历资料进行回顾性分析。结果共收集到符合入选标准的患者80例,其中未调整组62例(87.5%),调整组18例(22.5%)。二甲双胍停药时间为2~4 d。未调整组停药后空腹、早餐后2 h、午餐后2 h、晚餐后2 h和睡前血糖水平与停药前比较,均有不同程度的升高[(7.7±1.4)mmol/L比(7.0±1.2)mmol/L,(9.5±1.7)mmol/L比(9.0±1.8)mmol/L,(10.9±2.3)mmol/L比(8.6±1.9)mmol/L,(9.9±1.7)mmol/L比(8.6±1.7)mmol/L,(9.1±1.9)mmol/L比(8.5±1.6)mmol/L],其中空腹、午餐后2 h和晚餐后2 h血糖水平与停药前比较差异有统计学意义(P=0.01,P=0.00,P=0.00);调整组停用二甲双胍前后5个时间点血糖水平差异均无统计学意义[(7.9±1.2)mmol/L比(8.1±1.8)mmol/L,(8.0±2.2)mmol/L比(8.5±2.4)mmol/L,(9.2±2.9)mmol/L比(10.3±1.9)mmol/L,(9.4±2.1)mmol/L比(9.1±2.4)mmol/L,(10.0±2.3)mmol/L比(9.3±2.2)mmol/L,均P>0.05]。结论使用碘造影剂前后停用二甲双胍可导致停药期间未调整降糖治疗方案的糖尿病患者血糖水平出现有统计学意义的升高,调整降糖治疗方案有利于患者血糖水平控制更平稳。 Objective To investigate the effect of using metformin before and after iodine contrast medium on blood glucose level in diabetic patients. Methods Subjects were selected from January 1, 2012 to December 31, 2012 in Peking University First Hospital, patients admitted to the standard of choice for the use of metformin-containing regimen after treatment of basic compliance and maintain a stable, before and after the application of iodine contrast agent 48 h were stopped using metformin and fasting before and after withdrawal, 2 h after breakfast, 2 h after lunch, 2 h after dinner and before going to bed blood glucose monitoring records. Those who adjusted their hypoglycemic regimen during the discontinuation of metformin were included in the adjustment group and unadjusted treatment regimens were included in the unadjusted group. The medical records of two groups were collected for retrospective analysis. Results A total of 80 eligible patients were enrolled, of whom 62 (87.5%) were in the unadjusted group and 18 (22.5%) in the adjusted group. Metformin withdrawal time of 2 ~ 4 d. The unadjusted group after fasting, fasting, 2 h after breakfast, 2 h after lunch, 2 h after dinner and before going to bed blood glucose levels compared with before stopping, all have different degrees of increase [(7.7 ± 1.4) mmol / L ratio L compared with control group (7.0 ± 1.2) mmol / L, (9.5 ± 1.7) mmol / L vs (9.0 ± 1.8) mmol / L and (10.9 ± 2.3) mmol / L (9.1 ± 1.9) mmol / L (8.5 ± 1.6) mmol / L]. The fasting blood glucose levels at 2 hrs and 2 hrs after meal were significantly higher than those before d The difference was statistically significant (P = 0.01, P = 0.00, P = 0.00). There was no significant difference in blood glucose level between the two groups before and after metformin withdrawal in the adjustment group [(7.9 ± 1.2) mmol / L vs L, (1.8 ± 2.2) mmol / L (8.5 ± 2.4) mmol / L, (9.2 ± 2.9) mmol / L vs 10.3 ± 1.9 mmol / L and (9.4 ± 2.1) mmol / L (9.1 ± 2.4) mmol / L and (10.0 ± 2.3) mmol / L (9.3 ± 2.2) mmol / L, all P> 0.05] Conclusion The discontinuation of metformin before and after administration of iodine contrast medium can lead to a statistically significant increase in blood glucose levels in diabetics who did not adjust their hypoglycemic regimen during the discontinuation of treatment. Adjusting the regimen of hypoglycemic treatment favors a smoother blood glucose control.