静脉注射激素对合并2型糖尿病的重度慢性阻塞性肺疾病急性加重期患者疗效及安全性  

Efficacy and safety of intravenous hormone in patients with severe AECOPD complicated with type 2 dia⁃betes mellitus

作　　者：彭妙官[1] 邓雪峰[2] PENG Miaoguan;DENG Xuefeng(Department of Endocrinology,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510140,China;不详)

机构地区：[1]广州医科大学附属第三医院内分泌科,广州510140 [2]广州医科大学附属第一医院老年科,广州510120

出　　处：《实用医学杂志》2022年第20期2590-2596,共7页The Journal of Practical Medicine

基　　金：2012年第一批产业技术研究与开发资金计划项目(编号:2012B031800247)。

摘　　要：目的探讨合并2型糖尿病(type 2 diabetes,T2DM)的重度慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者综合治疗基础上联合静脉注射激素的疗效及安全性。方法筛选131例患者,其中9例因依从性问题退出,按随机数字表法,纳入67例使用静脉注射糖皮质激素治疗的患者(观察组),55例使用口服激素(对照组)。评价患者的治疗效果、炎症因子水平、肺功能及糖代谢指标,并比较不良反应。结果两组患者的治疗有效率不同,观察组(97.0%)比对照组(87.3%)更高,差异有统计学意义(P<0.05);观察组的住院时长更短[(11.2±2.0)vs.(14.1±2.2)d],差异均有统计学意义(P<0.001);出院时,相对于对照组,观察组的炎症因子水平均明显下降[IL⁃1β:(58.32±6.53)vs.(41.34±4.97)pg/mL;IL⁃18:(412.47±44.48)vs.(321.43±34.69)pg/mL;PCT:(0.067±0.006)vs.(0.042±0.012)ng/mL;hs⁃CRP:(10.86±0.77)vs.(7.32±0.89)mg/L],差异均有统计学意义(P值分别为<0.001、<0.001、0.019和<0.001);肺通气功能指标均改善[FEV1:(1.88±0.67)vs.(2.74±0.51)L;FEV1/FVC(%):(63.95±6.10)vs.(80.34±8.74);PEF(L/S)(2.08±0.37)vs.(2.67±0.47)],差异均有统计学意义(P<0.001);随访3个月时,两组糖代谢指标差异无统计学意义,观察组vs.对照组:[空腹血糖:(7.89±1.19)vs(.7.97±0.95)mmol/L,P=0.249;餐后2 h血糖:(10.28±1.33)vs.(10.22±1.21)mmol/L,P=0.438;HbA1c(%):(7.13±0.88)vs.(7.02±0.82),P=0.076],但住院期间胰岛素用量观察组(84.42±3.22)U较对照组(50.61±2.84)U更高,差异有统计学意义(P<0.001);两组间的不良反应发生率差异无统计学意义(P>0.05)。结论相比口服激素,静脉注射激素对合并T2DM的重度AECOPD患者更为有效,能改善肺通气功能,提高血氧水平,缩短住院时间,同步应用胰岛素的情况下能避免血糖恶化。Objective To explore the efficacy and safety of intravenous hormone combined with compre⁃hensive treatment in patients with severe acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with type 2 diabetes mellitus(T2DM).Methods Out of 131 screened patients,a total of 122 patients were included in the study,and 9 patients dropped out due to compliance issues.Patients were randomly divided into two groups,and receiving intravenous glucocorticoid(observation group,n=67)or oral hormone(control group,n=55).Outcome measures including therapeutic efficacy,inflammatory factor levels,pulmonary function and glucose levels and adverse events were evaluated.Results The effective rate between two groups was differ⁃ent,and the observation group(97.0%)was higher than that of the control group(87.3%),the difference was sta⁃tistically significant(P<0.05).The length of hospital stay in the observation group was shorter[(11.2±2.0)vs.(14.1±2.2)days],with statistically significant differences(P<0.001).At discharge,compared with the control group,the levels of inflammatory cytokines in the observation group were significantly decreased[IL⁃1β:(58.32±6.53)vs.(41.34±4.97)pg/mL;IL⁃18:(412.47±44.48)vs.(321.43±34.69)pg/mL;PCT:(0.067±0.006)vs.(0.042±0.012)ng/mL;hs⁃CRP:(10.86±0.77)vs.(7.32±0.89)mg/L],the differences were statistically significant(p values were < 0.001,< 0.001,0.019 and < 0.001,respectively=. The indexes of pulmonary ventila⁃tion function were improved[FEV1:(1.88 ± 0.67)vs.(2.74 ± 0.51)L;FEV1/FVC(%):PEF(L/S)(2.08 ±0.37)vs.(2.67 ± 0.47)],the differences were statistically significant(ALL P < 0.001). At 3⁃month follow⁃up,there were no significant differences in glucose metabolism indexes between the two groups,observation group vs.control group:[Fasting blood glucose:(7.89 ± 1.19)vs.(7.97 ± 0.95)mmol/L,P = 0.249;HbA1c(%):(7.13 ±0.88) vs.(7.02 ± 0.82),P = 0.076]. However,insulin dosage in the observation group(84.42 ± 3.22)U was higherthan that in the control group(5

关 键 词：糖皮质激素 糖尿病 慢性阻塞性肺疾病 肺功能 

分 类 号：R589.1[医药卫生—内分泌]