CAJ | 학술논문

目的研究持续性非卧床腹膜透析(CAPD)患者全天血糖谱的变化规律.方法选取2009年4月至2011年12月在中山大学附属第一医院腹膜透析中心行腹膜透析的终末期肾病患者28例,其中15例为2型糖尿病肾病患者(DN组),13例为非糖尿病肾病患者(NDN组).另设健康对照组12名,为同期来我院门诊体格检查各项指标均正常者.应用动态血糖监测系统(CGMS)对3组进行连续72 h的动态血糖监测,分析各组动态血糖参数特点.用多元协方差分析控制组间基线差异,并处理血红蛋白对HbA1c的影响效应.结果与正常对照组相比,NDN组＞11.1 mmol/L血糖百分比(PT)明显高于正常对照组,差异有统计学意义[(1％(0～5％)比0,P ＜0.05],且＞7.8 mmol/L曲线下面积(AUC)、＞11.IAUC、平均血糖水平的标准差(SDBG)、血糖最大值(MAX)、日内最大血糖波动幅度(LAGE)均有升高趋势(P值介于0.056 ～0.094).而DN组上述指标则更高.此外DN组平均血糖水平(MBG)、24 h AUC、透析相关指标如腹膜透析时血糖、透析后MAX也明显高于NDN组[(9.4±2.5)比(6.4± 1.3) mmol/L,(7.0±2.7)比(4.2±1.3) mmol·L-1·d-1,透析时血糖(8.6±2.8)比(6.2±1.4) mmol/L,透析后MAX(11.5±2.6)比(8.5±2.4) mmol/L](均P＜0.05).糖化血红蛋白＜7％的DN组患者的血糖指标如MBG、24 h AUC、＞7.8AUC及PT、＞11.1PT,腹膜透析相关指标如透析后MAX也较NDN组显著升高(t值为1.808 ～3.627,均P＜0.05).DN组的夜间低血糖检出率明显高于NDN组及正常对照组.在DN患者中,使用2.5％葡萄糖透析液与1.5％透析液的患者相比,各项血糖指标均有升高趋势(均P＞0.05).结论 CAPD时葡萄糖腹膜透析液可影响患者的血糖稳态,对DN患者的影响更为明显.
목적 연구지속성비와상복막투석(CAPD)환자전천혈당보적변화규률.방법 선취2009년4월지2011년12월재중산대학부속제일의원복막투석중심행복막투석적종말기신병환자28례,기중15례위2형당뇨병신병환자(DN조),13례위비당뇨병신병환자(NDN조).령설건강대조조12명,위동기래아원문진체격검사각항지표균정상자.응용동태혈당감측계통(CGMS)대3조진행련속72 h적동태혈당감측,분석각조동태혈당삼수특점.용다원협방차분석공제조간기선차이,병처리혈홍단백대HbA1c적영향효응.결과 여정상대조조상비,NDN조＞11.1 mmol/L혈당백분비(PT)명현고우정상대조조,차이유통계학의의[(1％(0～5％)비0,P ＜0.05],차＞7.8 mmol/L곡선하면적(AUC)、＞11.IAUC、평균혈당수평적표준차(SDBG)、혈당최대치(MAX)、일내최대혈당파동폭도(LAGE)균유승고추세(P치개우0.056 ～0.094).이DN조상술지표칙경고.차외DN조평균혈당수평(MBG)、24 h AUC、투석상관지표여복막투석시혈당、투석후MAX야명현고우NDN조[(9.4±2.5)비(6.4± 1.3) mmol/L,(7.0±2.7)비(4.2±1.3) mmol·L-1·d-1,투석시혈당(8.6±2.8)비(6.2±1.4) mmol/L,투석후MAX(11.5±2.6)비(8.5±2.4) mmol/L](균P＜0.05).당화혈홍단백＜7％적DN조환자적혈당지표여MBG、24 h AUC、＞7.8AUC급PT、＞11.1PT,복막투석상관지표여투석후MAX야교NDN조현저승고(t치위1.808 ～3.627,균P＜0.05).DN조적야간저혈당검출솔명현고우NDN조급정상대조조.재DN환자중,사용2.5％포도당투석액여1.5％투석액적환자상비,각항혈당지표균유승고추세(균P＞0.05).결론 CAPD시포도당복막투석액가영향환자적혈당은태,대DN환자적영향경위명현.
Objective To investigate 24-hour blood glucose profile and blood glucose fluctuation following peritoneal exchange in patients with end stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) with glucose-based peritoneal dialysis solution.Methods A total of 28 patients receiving CAPD due to ESRD were enrolled,of whom 15 subjects with diabetic nephropathy (DN group) and 13 were free of diabetes (NDN group).Data of 12 healthy volunteers (control group) was also analyzed.Patients of three groups were evaluated by continuous glucose monitoring systems (CGMS) and the parameters were measured.Results ＞ 11.1 percentage of time (PT) was higher in NDN group than that in control group (1％ (0-5％) vs 0) (P ＜ 0.05).There were no significant difference of ＞ 7.8 area under curve (AUC),＞ 11.1 AUC,standard deviation of blood glucose (SDBG),maximum glucose (MAX) and large amplitude of glycogenic excursion(LAGE) (P value between 0.056 and 0.094).Compared to healthy volunteers group,patients in DN group presented higher CGMS parameters.Patients in DN group also presented higher mean blood glucose(MBG),24-hour AUC,BG during peritoneal exchange(PE) and MAX after PE,compared with NDN group((9.4 ± 2.5) vs (6.4 ± 1.3) mmol/L,(7.0 ± 2.7) vs (4.2 ± 1.3)mmol · L-1 · d-1,(8.6 ±2.8) vs (6.2 ± 1.4) mmol/L,(11.5 ±2.6) vs (8.5 ±2.4) mmol/L,all P ＜0.05).Patients with DN and HbA1c ＜7％ also displayed higher MBG,24-hour AUC,＞7.8AUC and ＞7.8PT,＞ 11.1 PT and MAX after PE than NDN group(t ＝ 1.808-3.627,all P ＜0.05).Hypoglycemia events occurring at night in DN group was higher than that in NDN group and control group.There was no significant difference of the impact on blood glucose level with the use of 1.5％ or 2.5％ peritoneal solution in the diabetic nephropathy patients group (all P ＞ 0.05).Conclusion Continuous ambulatory peritoneal dialysis with glucose-based peritoneal dialysis solution may impose disturbance to glucose homeostasis in patients with ESRD,with a more significant impact in those with diabetic nephropathy.