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目的:观察住院糖尿病患者中空腹高血糖的状况并分析其相关因素。方法:选取2013年1月—2014年12月在5家医院行动态血糖监测、资料完整的住院糖尿病患者1 055例。收集性别、年龄、糖尿病分型、病程、体重指数(BMI)、血压、糖化血红蛋白(Hb A1c)、血脂、尿白蛋白、大血管病变等临床资料,分析相关因素。结果:在住院糖尿病患者中,83.9%存在空腹高血糖,其中全天血糖控制不佳占75.2%,黎明现象占15.4%,Somogyi效应占9.4%。1型糖尿病患者Somogyi效应发生率显著高于2型,2型糖尿病患者全天不佳发生率显著高于1型。单因素分析结果显示在3个亚组中年龄、分型、病程、血压、血脂具有差异性(P<0.05)。二分类Logistic分析结果显示年龄越大、病程越长、甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-C)越高,全天血糖控制不佳发生的风险越大(P<0.05),年龄越小、病程越短、收缩压越高、总胆固醇(TC)越高,黎明现象发生的风险越大(P<0.05),TC、TG越低,Somogyi效应发生的风险越大(P<0.05)。结论:住院糖尿病患者中普遍存在空腹高血糖现象,原因依次为全天血糖控制不佳、黎明现象、Somogyi效应。1型糖尿病更容易发生Somogyi效应。年龄、病程、TG、LDL-C为全天血糖控制不佳的危险因素,年龄、病程、收缩压、TC为黎明现象的危险因素,TC、TG为Somogyi效应的危险因素。
Objective: To observe the status of fasting hyperglycemia in hospitalized diabetic patients and analyze the related factors. Methods: A total of 1 055 inpatients with in-hospital diabetes were enrolled in our hospital from January 2013 to December 2014. Gender, age, type of diabetes, course of disease, body mass index (BMI), blood pressure, Hb A1c, blood lipids, urinary albumin, macrovascular disease and other clinical data were collected to analyze the relevant factors. Results: Fasting hyperglycemia was found in 83.9% of inpatients with diabetes. Among them, 75.2% had poor control of blood glucose throughout the day, 15.4% at dawn and 9.4% with Somogyi. The prevalence of Somogyi in type 1 diabetic patients was significantly higher than that in type 2 diabetic patients, and the incidence of unproven day 2 diabetes was significantly higher than that of type 1 diabetic patients. Univariate analysis showed that age, type, course of disease, blood pressure and blood lipids were different among the three subgroups (P <0.05). Logistic analysis showed that the higher the age, the longer the course, the higher the triglyceride (TG) and low density lipoprotein cholesterol (LDL-C), the greater the risk of poor control of blood glucose during the whole day (P <0.05) (P <0.05). The lower the TC, TG, the higher the risk of Somogyi effect (P <0.05). Conclusion: Fasting hyperglycemia is commonly found in hospitalized patients with diabetes due to poor control of blood glucose throughout the day, dawn phenomenon and Somogyi effect. Type 1 diabetes is more prone to Somogyi effect. Age, course of disease, TG and LDL-C are risk factors for poorly controlled blood glucose throughout the day. Age, course of disease, systolic blood pressure, and TC are risk factors for dawn. TC and TG are risk factors for Somogyi effect.