住院患者低血糖症的病因分析及鉴别方法初探  

Etiological analysis and differential diagnosis of hypoglycemia in hospitalized patients

作　　者：廖静 丁霏 罗薇 李贵星[1] LIAO Jing;DING Fei;LUO Wei;LI Guixing(Department of Laboratory Medicine,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西医院实验医学科

出　　处：《国际检验医学杂志》2020年第2期205-208,共4页International Journal of Laboratory Medicine

基　　金：四川省科技支撑项目(2016SZ0044)

摘　　要：目的分析住院低血糖患者的病因及其构成情况,探究鉴别真性和假性低血糖的方法,建立低血糖结果的分析流程。方法回顾性分析2016年1月至2018年8月四川大学华西医院1413例低血糖住院患者的临床资料及实验室数据,按真性和假性低血糖、器质性和非器质性低血糖分类分析,并进一步将器质性和非器质性低血糖按病因分类分析。结果1413例低血糖患者中,病因明确的低血糖1147例(81.17%),病因不明的266例(18.83%)。1147例病因明确的低血糖患者中真性低血糖709例(61.81%),假性低血糖438例(38.19%)。病因明确的低血糖按具体病因分为器质性低血糖(n=149,12.99%)和非器质性低血糖(n=998,87.01%)2大类。149例器质性低血糖包括肝源性低血糖77例(51.68%),胰腺肿瘤性低血糖43例(28.86%),内分泌性低血糖18例(12.08%),反应性低血糖6例(4.03%),胰外肿瘤性低血糖3例(2.01%),胰岛素自身免疫综合征性低血糖2例(1.34%)。998例非器质性低血糖包括进食不足508例(50.90%),标本放置过久408例(40.88%),降糖药物使用不当52例(5.21%),红/白细胞增多30例(3.01%)。结论住院患者发生低血糖有真性和假性低血糖之分,同时,真性低血糖的病因复杂多样,临床工作中要准确诊断和鉴别诊断并采取正确的措施。Objective To analyze the etiology of hypoglycemia,explore the method of distinguishing true hypoglycemia from false hypoglycemia and establish the analysis process of hypoglycemia results.Methods The clinical details and laboratory tests data of 1413 hospitalized patients with hypoglycemia in West China Hospital of Sichuan University,from January 2016 to August 2018,were retrospectively analyzed.True and false hypoglycemia,organic and non-organic hypoglycemia were classified and analyzed.Organic and non-organic hypoglycemia were further classified according to different etiology.Results Among the 1413 patients with hypoglycemia,1147(81.17%)had clear causes,and 266(18.83%)were unknown.Among 1147 cases of hypoglycemia with definite causes,709 cases(61.81%)were true hypoglycemia and 438 cases(38.19%)were false hypoglycemia.According to the etiology,they were divided into two groups:organic hypoglycemia(n=149,12.99%)and non-organic hypoglycemia(n=998,87.01%).149 cases of organic hypoglycemia included:77 cases of hepatic hypoglycemia(51.68%),43 cases of pancreatic tumorous hypoglycemia(28.86%),18 cases of endosecretory hypoglycemia(12.08%),6 cases of reactive hypoglycemia(4.03%),3 cases of extra-pancreatic tumorous hypoglycemia(2.01%)and 2 cases of insulin autoimmune syndrome hypoglycemia(1.34%).Among the 998 cases of non-organic hypoglycemia,there were 508 cases(50.90%)with lacking of energy,408 cases(40.88%)with long time of placement,52 cases(5.21%)with improper use of hypoglycemic drugs,and 30 cases(3.01%)with increased red/white blood cells.Conclusion There were true hypoglycemia and false hypoglycemia.Meanwhile,the causes of true hypoglycemia are complex and diverse.Accurate diagnosis and correct measures should be taken in clinical work.

关 键 词：真性低血糖 假性低血糖 病因 鉴别诊断 

分 类 号：R583.3[医药卫生—内分泌]