类固醇糖尿病患者53例临床特点分析  

A Clinical Analysis of 53 Patients with Steroid Diabetes Mellitus

作　　者：邱杰山[1] 胡作祥[1] 沈水娟[1] 李青华[1] 王时敏[1] 

机构地区：[1]浙江省绍兴市人民医院肾内科,312000

出　　处：《医学研究杂志》2012年第10期106-109,共4页Journal of Medical Research

摘　　要：目的观察类固醇糖尿病(SDM)患者的一般临床表现、血糖波动特点及血清胰岛素(INS)及C肽释放特点,探讨SDM的发病机制,以期有助于对SDM的早期诊断及合理治疗。方法服用糖皮质激素(GC)治疗的患者53例,收集患者的一般临床资料,并行INS及C肽释放试验,与正常对照组进行比较。结果年龄、阳性家族史等是GC诱发SDM的高危因素。尿糖、糖化血红蛋白A1c(HbA1c)的测定有助于对SDM的早期诊断。SDM患者全天血糖波动呈现下午至睡前血糖较高而早晨及空腹血糖仅轻度升高的特点。SDM组患者30min及60min血清INS及C肽均较正常对照组低(P<0.01),提示SDM患者体内INS存在相对或绝对不足。SDM患者血清INS及C肽的达峰时间较正常对照组明显延迟(P<0.01),且SDM患者180min血清INS及C肽水平均未恢复至空腹水平(P<0.05),提示SDM患者存在胰岛β细胞分泌功能异常和胰岛素抵抗(IR)。结论需提高对SDM早期诊断的警惕性,INS相对或绝对不足、胰岛β细胞分泌功能异常和IR是SDM发生、发展的重要机制。Objective To investigate the characteristics of clinical manifestations, blood glucose fluctuations, insulin （INS） release and C - peptide release of the patients with steroid diabetes mellitus（SDM） , in order to contribute to the early diagnosis and treatment of SDM. Methods Information of total 53 patients with chronic kidney disease （CKD） who took glucocorticoid （GC） treatment were col- lected. The INS and C peptide release tests were done. Results Age and positive family history were the high risk factors inducing the development of SDM in patients who took the GC treatment. The positive expression of urine glucose and elevated glycosylated hemoglobin A1 c （HbAlc） were helpful for the early diagnosis of SDM. Blood glucose elevated significantly during the period from post - lunch to bed- time but morning and fasting blood glucose only mildly elevated were the characteristics in patients with SDM. In the group of SDM, INS and C peptide were lower than the normal control group in 30min and 60rain（ P 〈 0.01 ）, suggesting that there was a considerable or abso- lute insulin deficiency. In patients with SDM, the peak time of INS and C peptide was significantly delayed（P 〈 0.01 ） , the levels of INS and C peptide could not restore to the levels of empty stomach（ P 〈 0.05 ） , suggesting that there was a dysfunction of [3 - cell and insulin resistance. Conclusion The vigilance of early diagnosis of SDM should be improved. Relative or absolute deficiency of insulin, islet 13 - cell secretary dysfunction and insulin resistance were important mechanisms in the development of SDM.

关 键 词：类固醇糖尿病 胰岛素 C肽 临床特点 

分 类 号：R587.1[医药卫生—内分泌]