CAJ | 학술논문

目的探讨天疱疮和类天疱疮患者糖皮质激素诱导性糖尿病(GDM)的发生情况和相关危险因素.方法收集2011年12月至2013年1月接受糖皮质激素(激素)治疗的天疱疮和类天疱疮住院患者,比较发生GDM和未发生GDM两组患者的年龄、性别、体质指数(BMI)、病理类型、糖皮质激素的起始剂量、日激素最大剂量、糖尿病家族史、免疫抑制剂治疗等因素的差异.组间比较采用独立样本t检验,应用x2检验和Fisher确切概率法对计数资料进行分析;用Logistic回归模型进行危险因素分析.结果经糖皮质激素治疗的68例天疱疮和类天疱疮患者中,26例(38.2％)发生了GDM.在发生和未发生糖尿病两组患者间进行单因素分析,结果显示:激素起始量(P＜ 0.05;OR 1.023;95％ CI 1.002～ 1.044)、日激素最大剂量(P＜ 0.01;OR 1.037;95％ CI 1.013～1.062)、激素治疗时间(P＜0.05;OR 1.143;95％CI1.028～ 1.271)、BMI(P＜ 0.01;OR 1.265;95％CI1.080～ 1.481)、地塞米松使用(P＜ 0.01;OR 6.0;95％ CI 1.887～19.076)是天疱疮和类天疱疮患者发生GDM的危险因素.多因素Logistic回归分析显示:BMI(P＜ 0.05; OR 1.223;95％ CI 1.017 ～ 1.471)和日激素最大剂量(P＜ 0.05;OR 1.037;95％ CI 1.009 ～ 1.065)是GDM发生的独立危险因素.结论 38.2％的天疱疮和类天疱疮患者经糖皮质激素治疗后发生了GDM,BMI和日激素最大剂量可能是GDM发生的独立危险因素.
목적 탐토천포창화류천포창환자당피질격소유도성당뇨병(GDM)적발생정황화상관위험인소.방법 수집2011년12월지2013년1월접수당피질격소(격소)치료적천포창화류천포창주원환자,비교발생GDM화미발생GDM량조환자적년령、성별、체질지수(BMI)、병리류형、당피질격소적기시제량、일격소최대제량、당뇨병가족사、면역억제제치료등인소적차이.조간비교채용독립양본t검험,응용x2검험화Fisher학절개솔법대계수자료진행분석;용Logistic회귀모형진행위험인소분석.결과 경당피질격소치료적68례천포창화류천포창환자중,26례(38.2％)발생료GDM.재발생화미발생당뇨병량조환자간진행단인소분석,결과현시:격소기시량(P＜ 0.05;OR 1.023;95％ CI 1.002～ 1.044)、일격소최대제량(P＜ 0.01;OR 1.037;95％ CI 1.013～1.062)、격소치료시간(P＜0.05;OR 1.143;95％CI1.028～ 1.271)、BMI(P＜ 0.01;OR 1.265;95％CI1.080～ 1.481)、지새미송사용(P＜ 0.01;OR 6.0;95％ CI 1.887～19.076)시천포창화류천포창환자발생GDM적위험인소.다인소Logistic회귀분석현시:BMI(P＜ 0.05; OR 1.223;95％ CI 1.017 ～ 1.471)화일격소최대제량(P＜ 0.05;OR 1.037;95％ CI 1.009 ～ 1.065)시GDM발생적독립위험인소.결론 38.2％적천포창화류천포창환자경당피질격소치료후발생료GDM,BMI화일격소최대제량가능시GDM발생적독립위험인소.
Objective To investigate the prevalence of and risk factors for glucocorticoid-induced diabetes mellitus (GDM) in patients with pemphigus or pemphigoid receiving glucocorticoid therapy.Methods This study included 68 hospitalized patients with pemphigus or pemphigoid receiving glucocorticoid therapy in the Institute of Dermatology,Chinese Academy of Medical Sciences and Peking Union Medical College from December 2011 to January 2013.Comparisons were carried out between patients with GDM and those without regarding multiple parameters,including age,sex,body mass index (BMI),pathological type,initial dose and maximum daily dose of glucocorticoids,family history of diabetes mellitus,immunosuppressive treatment,etc.Independent samples t test was used for intergroup comparisons,Chi-square test and Fisher exact probability test for the analysis of count data,and a logistic regression model for the determination of risk factors.Results Among the 68 patients,26 (38.2％) developed GDM during glucocorticoid therapy.Univariate logistic regression analysis showed that the initial dose of glucocorticoids (P ＜ 0.05,OR 1.023,95％ CI 1.002-1.044),maximum daily dose of glucocorticoids(P ＜ 0.01,OR 1.037,95％ CI 1.013-1.062),duration of glucocorticoid treatment (P ＜ 0.05,OR 1.143,95％ CI 1.028-1.271),BMI (P ＜ 0.01,OR 1.265,95％ CI 1.080-1.481) and dexamethasone use (P ＜ 0.01,OR 6.0,95％ CI 1.887-19.076) were risk factors for GDM in these patients.Multivariate logistic regression analysis showed that BMI (P ＜ 0.05,OR 1.223,95％ CI 1.017-1.471) and maximum daily dose of glucocorticoids (P ＜ 0.05,OR 1.037,95％ CI 1.009-1.065) were independent risk factors for GDM.Conclusions In this study,38.2％ of the patients with pemphigus or pemphigoid developed GDM during glucocorticoid therapy.BMI and maximum daily dose of glucocorticoids seem to be independent risk factors for GDM.