2型糖尿病患者发生严重低血糖事件危险因素分析  

Analysis of risk factors for severe hypoglycemia in type 2 diabetes mellitus

作　　者：朱平[1] 冉建民[1] 劳干诚[1] 

机构地区：[1]暨南大学医学院第四附属医院广州市红十字会医院内分泌科,广州510220

出　　处：《中华老年医学杂志》2013年第12期1289-1293,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金青年项目（81200613）

摘　　要：目的探讨2型糖尿病（T2DM）患者治疗过程中发生严重低血糖的危险因素，为临床糖尿病患者低血糖的预防提供帮助。方法选择2010年9月至2012年10月因严重低血糖而收入院的T2DM患者49例，并选取同期非低血糖住院的T2DM患者98例作为对照。严重低血糖是指糖尿病患者发生低血糖后需要外界的帮助并输注碳水化合物后缓解，同时监测血糖≤3．9mmol／L。采用单因素分析比较两组间临床和生化指标，进一步通过多因素回归分析，建立Logistic模型，用ROC曲线评价Logistic模型的预报能力。结果低血糖组低血糖发作时平均血糖水平为（2．3±0．7）mmol／L。低血糖组平均年龄（76．2±6．5）岁，高于非低血糖组[（69．8±11．5）岁，P一0．0013；糖化血红蛋白（HbAlc）水平低于非低血糖组[（6．4±0．8）％比（9．1±2．5）％，P〈0．001]；内生肌酐清除率（Ccr）低于非低血糖组[（46．8士21．O）ml／min比（74．2士24．5）ml／min，P〈0．0013。多变量二分类Logistic回归分析显示，性别（OR=11．83，95％CI1．82N76．93）、Ccr（OR=0．91，95％C10．86～0．97）和HbAlc（OR：0．18，95％C10．08～O．44）是发生严重低血糖的独立危险因素；胰岛素（OR=12．31，95％CI1．70~88．88）和胰岛素促泌剂（OR=5．36，95％CI1．08～26．56）等降糖方案增加了低血糖发生的风险。而糖尿病病程、体质指数和尿微量白蛋白对低血糖发生的影响差异无统计学意义（P〉0．05）。Logistic模型的ROC曲线下面积为96．5％。结论T2DM患者严重低血糖事件中性别、Ccr、HbAlc、胰岛素和胰岛素促泌剂的使用是主要危险因素，对于高危患者应及早采取措施预防低血糖的发生。Objective To investigate the risk factors for severe hypoglycemia in the treatment of type 2 diabetes mellitus （T2DM） and to provide scientific rationales for the prevention of hypoglycemia in treating diabetes. Methods Clinical data of 49 T2DM patients with severe hypoglycemia （hypoglycemic group） and 98 T2DM patients without hypoglycemia as control group were retrospectively analyzed. Severe hypoglycemia was defined as that patient requiring assistance for intaking carbohydrate to alleviate hypoglycemia and plasma glucose concentration was less than 3.9 mmol/L. Clinical and biochemical indexes were analyzed by the single-factor analysis. Logistic regression model was established by multi-factors regression analysis, and the receiver operating characteristic （ROC） curve was used to assess the performance of the logistic regression model. Results The mean serum glucose level was （2.3＋0.7） mmol/L during hypoglycemia in hypoglycemia group. The mean age was higher in hypoglycemia group than in control group （（76. 2--＋-_6. 5） years vs. （69.8i11.5） years, P=0. 001±. The mean glyeosylated hemoglobin Ale （HbAlc） level was lower in hypoglycemia group than in control group （（6.4-＋-0.8）% vs. （9.1-＋- 2.5）%,P±0.0013. Endogenous creatinine clearance rate （Ccr） was lower in hypoglycemia group than in control group （（46.8±21.0） ml/min vs. （74.2±24.5） ml/min,P〈0. 001]. Logistic regression analysis indicated that female and HbAlc level were the independent risk factors for severe hypoglycemia （OR= 11.83,0.91 and0.18, 95~CI： 1.82-76.93, 0.86-0.97 and 0.08-0.44, respectiely~; T2DM therapies with insulin and insulin secretagogues increased the risk of hypoglycemia （OR= 12.31 and 5.36, 95 ~CI： 1.70-88.88 and 1.08-26.56） ; however, duration of diabetes, body mass index （BMI）, and urinary microalbumin （UMA） had no correlation with severe hypoglycemia （all P^0.05）. The area under the ROC curve was 96.5% by the logistic regression model. Conclusions

关 键 词：糖尿病 2型 低血糖症 危险因素 

分 类 号：R587.2[医药卫生—内分泌]