CAJ | 학술논문

目的探讨肾功能正常的2型糖尿病患者的血肌酐与血乳酸水平的关系以及应用二甲双胍后对血乳酸的影响.方法选择肾功能正常的住院2型糖尿病患者723例,其中应用二甲双胍者(用药组)275例,未用双胍类者(对照组)448例.用酶电极法测定血乳酸水平,同时榆测空腹血糖、胰岛素、HbA1C尿素氮、肌酐和丙氨酸转氨酶(ALT)等水平.结果 (1)用药组的平均血乳酸水平高于对照组[(1.33±0.57 vs 1.17±0.47)mmol/L,P<0.01];高乳酸血症的发生率显著高于对照组(9.45% vs 4.91%,P<0.01),但均末达到酸中毒的水平.(2)相关性分析结果显示,血乳酸水平与血肌酐、尿素氮、ALT、体重指数(BMI)呈明显正相关.在校正ALT和BMI后,肌酐仍与血乳酸呈正相关(r=0.345,P<0.01).(3)按肌酐水平进行分层后,血乳酸水平随着血肌酐水平升高而增加,肌酐>90 μmol/L后显著增高;受试者工作特征(ROC)曲线分析表明预测血乳酸水平增高的肌酐截点是95.35 μmol/L.结论肾功能正常的2型糖尿病患者应用二甲双胍虽具有较好的安全性,但仍有极少数患者可出现乳酸水平的轻度升高.血肌酐>95.35μmol/L者发生高乳酸血症的风险增加.
목적 탐토신공능정상적2형당뇨병환자적혈기항여혈유산수평적관계이급응용이갑쌍고후대혈유산적영향.방법 선택신공능정상적주원2형당뇨병환자723례,기중응용이갑쌍고자(용약조)275례,미용쌍고류자(대조조)448례.용매전겁법측정혈유산수평,동시유측공복혈당、이도소、HbA1C뇨소담、기항화병안산전안매(ALT)등수평.결과 (1)용약조적평균혈유산수평고우대조조[(1.33±0.57 vs 1.17±0.47)mmol/L,P<0.01];고유산혈증적발생솔현저고우대조조(9.45% vs 4.91%,P<0.01),단균말체도산중독적수평.(2)상관성분석결과현시,혈유산수평여혈기항、뇨소담、ALT、체중지수(BMI)정명현정상관.재교정ALT화BMI후,기항잉여혈유산정정상관(r=0.345,P<0.01).(3)안기항수평진행분층후,혈유산수평수착혈기항수평승고이증가,기항>90 μmol/L후현저증고;수시자공작특정(ROC)곡선분석표명예측혈유산수평증고적기항절점시95.35 μmol/L.결론 신공능정상적2형당뇨병환자응용이갑쌍고수구유교호적안전성,단잉유겁소수환자가출현유산수평적경도승고.혈기항>95.35μmol/L자발생고유산혈증적풍험증가.
Objective To study the relationship between plasma creatinine and lactic acid levels in type 2 diabetic patients with normal renal function, and the effect of mefformiu administration on plasma lactic acid. Methods Blood samples were collected from 723 type 2 diabetic inpatients(275 cases treated with mefformin as treatment group and 448 without mefformin as control group). Plasma lactic acid was measured with enzyme-electrode assay. The fasting plasma glucose, fasting insulin, creatinine (Cr) , alanine aminotransferase (ALT), and HbA1C levels were also determined. Results (1) The lactic acid level in treatment group was significantly higher than that in control group [(1.33±0.57 vs 1.17±0.47) mmol/L, P<0.01] and so was the incidence of hyperlactacidemia (9.45% vs 4.91%, P<0.01). No lactic acidosis was found in all patients. (2) The correlation analysis showed that Cr, blood urea nitrogen, ALT and body mass index (BMI) were positively correlated with lactic acid in control group, and the positive correlation between Cr and lactic acid still existed (r= 0.345, P<0.01) after adjustment for ALT and BMI. (3) After being divided by 20 μmol/L Cr in control group, lactic acid levels in subgroup increased with the Cr levels, especially when Cr was over 90 μmol/L. The Cr cutpoint for predicting lactatemia was 95.35 μmol/L. Conclusion It is safe to administrate metformin in type 2 diabetic patients with normal renal function, along with low risk of lactic acidemia. The incidence of lactic acidemia may increase when plasma Cr level reaches 95.35 μmol/L,