基于动态血糖监测系统的2型糖尿病患者低血糖发作的相关因素  

Research on related factors for hypoglycemic episodes in patients with type 2 diabetes mellitus based on continuous glucose monitoring system

作　　者：张雅文 张琼月 陶珺珺[1] 苗青 曾芳芳 周丽诺 杨叶虹 ZHANG Ya-wen;ZHANG Qiong-yue;TAO Jun-jun;MIAO Qing;ZENG Fang-fang;ZHOU Li-nuo;YANG Ye-hong(Department of Endocrinology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Endocrinology,Huashan Hospital North,Fudan University,Shanghai 201900,China;Shanghai Key Laboratory of Metabolic Remodeling and Health-Institute of Metabolism&Integrative Biology,Fudan University,Shanghai 200433,China)

机构地区：[1]复旦大学附属华山医院内分泌科,上海200040 [2]复旦大学附属华山医院北院内分泌科,上海201900 [3]上海市代谢重塑与健康重点实验室-复旦大学代谢与整合生物学研究院,上海200433

出　　处：《复旦学报（医学版）》2021年第5期637-647,共11页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(81670751);国家重点研发计划(2016YFC1305105);上海市卫计委青年基金(20144Y0070);中国博士后科学基金(2021M690680)。

摘　　要：目的通过动态血糖监测(continuous glucose monitoring,CGM)系统评估2型糖尿病(type 2 diabetes mellitus,T2DM)患者低血糖发作的相关因素。方法纳入147例2018年12月—2019年10月间在华山医院内分泌代谢科病房接受为期5天的CGM的T2DM患者,收集患者的一般资料、实验室参数以及动态血糖参数。根据监测期间是否有低血糖发作将患者分为非低血糖组和低血糖组,将单次低血糖发作定义为传感器监测血糖<3.9 mmol/L并持续15 min以上。动态血糖参数包括平均血糖(mean blood glucose,MBG)、标准差(standard deviation,SD)、变异系数(coefficient of variation,CV)、血糖值极差(ΔBG)、平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)以及血糖在<3.9 mmol/L、3.9~7.8 mmol/L、>7.8 mmol/L、3.9~10.0 mmol/L、>10.0 mmol/L范围内的时间百分比(%TIR)。结果Logistic回归分析显示,较低水平的肾小球滤过率(estimated glomerular filtration rate,eGFR)、胰岛素及其类似物应用的增加以及较低的MBG水平是低血糖发作的相关因素。Spearman相关性分析显示MBG水平、血糖>7.8 mmol/L及血糖>10.0 mmol/L范围内的%TIR与低血糖发作呈负相关,但是血糖变异水平(SD、CV、ΔBG、MAGE)以及血糖在3.9~7.8 mmol/L范围内的%TIR与低血糖发作呈正相关。Pearson相关性分析显示,低血糖发作时长与磺脲类药物的使用和CV水平呈正相关。结论较低水平的肾小球滤过率、胰岛素及其类似物应用的增加以及较低水平的MBG是T2DM患者低血糖发作的相关因素。Objective To identify related factors for hypoglycemic episodes in patients with type 2 diabetes mellitus(T2DM)through continuous glucose monitoring(CGM).Methods The included 147 patients with T2DM were those who had undergone CGM for 5 days in our ward of Department of Endocrinology and Metabolism,Huashan Hospital from Dec 2018 to Oct 2019.The general information,laboratory parameters and CGM parameters of the patients were collected.According to whether there was an episode of hypoglycemia during the monitoring period,the patients were divided into non-hypoglycemia group and hypoglycemic group.A single hypoglycemia episode was defined as a sensor monitoring blood glucose of less than 3.9 mmol/L and lasting for more than 15 minutes.CGM parameters included the mean blood glucose(MBG),standard deviation(SD),coefficient of variation(CV),the differences between maximum and minimum blood glucose(BG)levels(ΔBG),mean amplitude of glycemic excursions(MAGE)and the percentage of time in range(%TIR)of BG at<3.9 mmol/L,3.9-7.8 mmol/L,>7.8 mmol/L,3.9-10.0 mmol/L,and>10.0 mmol/L.Results Logistic regression analysis showed that lower estimated glomerular filtration rate(eGFR)levels,increased use of insulin and its analogs and lower MBG levels were associated with hypoglycemic episodes.Spearman correlation analysis showed that the MBG level and the%TIR of BG>7.8 mmol/L and BG>10.0 mmol/L were negatively associated while glycemic variability(GV)levels(SD,CV,ΔBG,MAGE)and%TIR of BG at 3.9-7.8 mmol/L were positively associated with hypoglycemic episodes.Pearson correlation analysis showed that the duration of hypoglycemic episodes was positively correlated with the use of sulfonylureas and CV levels.Conclusion Lower eGFR levels,increased treatment with insulin and its analogs and lower MBG levels were related factors for hypoglycemic episodes in patients with T2DM.

关 键 词：低血糖 动态血糖监测(CGM) 2型糖尿病(T2DM) 肾小球滤过率(eGFR) 胰岛素 

分 类 号：R587.1[医药卫生—内分泌]