2型糖尿病患者口服保健品引发乳酸酸中毒的临床分析

Clinical study of type 2 diabetes patients taking health products with lactic acidosis

目的：分析口服保健品的2型糖尿病患者并发乳酸酸中毒的临床特征，探讨2型糖尿病并发乳酸酸中毒危险因素，总结治疗经验，降低病死率。方法采用回顾性分析，将2011年1月～2014年2月我院收治的43例2型糖尿病并乳酸酸中毒患者分为乳酸≥13.0mmol/L 组（A 组，20例），乳酸＜13.0mmol/L（B组，23例），比较两组患者临床及实验室指标、治疗方法及转归。结果 A 组死亡率为15%，显著高于 B组（P ＜0.05）；A 组糖尿病病程、白细胞计数、阴离子间隙、血肌酐、尿素氮较 B 组显著性升高（P ＜0.05）；A 组 SO2%、Hb、pH 值、CO2CP、血糖、HbA1C%显著低于 B 组（P ＜0.05）；Pearson 相关性分析显示，补碱量与乳酸、pH 值水平无显著相关性（P ＞0.05），r 值分别为0.041、0.101。结论警惕“消渴平糖、平糖养胰”等含不明降糖成份的保健品引发糖尿病乳酸酸中毒，糖尿病病程、炎症、肾功能不全、低氧血症为糖尿病患者乳酸升高的危险因素，补碱量与乳酸、pH 值无相关性。

Objective To analyze the clinical characteristics and risk factors of type 2 daibetes patients with lactic acidosis, to summarize the trentment experience and reduce morbidity. Methods 43 cases of T2DM with lactic acidosis of the January 2011- February 2014 in our hospital were divided into lactic acidosis greater than or equal to 13.0mmol/L group （A group, 20cases）and lactate levels less than 13.0mmol/L（group B,23cases） .The clinical and laboratory parameters and treatment and prognosis of two groups were retrospectively analyzed. Results Mortality of group A was 15%, significantly higher than group B, P 〈 0.05. Diabetes duration white blood cell count, anion gap, serum creatinine and blood urea nitrogen of group A were significantly higher than that in group B, P 〈 0.05. SO2%, Hb, pH value, CO2cp, blood glucose and HbA1C% of group A were significantly lower than that in group, P 〈 0.05. Pearson correlation analysis showed that the amount of alkali supplement, pH value and lactate levels were not significantly correlated, r values were 0.041and 0.101, P 〈 0.05. Conclusion We should to vigilance xiaokepingtang, pingtangyangyi and other hypoglycemic ingredients of unknown health products lead to diabetes lactic acidosis. Duration of diabetes, inflammation, renal dysfunction and hypoxemia in patients were risk factors for diabetes patients complicating lactic acidosis, there was no correlation between amount of alkali and lactate or pH value levels .