腹膜透析对糖尿病患者血糖波动的影响及临床意义

Effect of peritoneal dialysis on glycemic variability in patients with diabetes and its clinical implications

目的利用持续动态血糖监测系统(CGMS)比较糖尿病腹膜透析患者和肾功能正常糖尿病患者血糖谱,探讨腹膜透析对糖尿病患者血糖波动的影响。方法选取规律腹膜透析的终末期糖尿病肾病(DMPD组,n=19)和非糖尿病肾病患者(PD组,n=8),并根据年龄、性别和72h平均血糖匹配肾功能正常糖尿病患者(DM组,n=20),应用CGMS进行连续72h动态血糖监测,比较腹透糖尿病和肾功能正常糖尿病及非糖尿病腹透患者血糖波动的特点。结果腹膜转运功能和平均血糖、标准差和平均有效血糖波动幅度显著正相关。和PD组相比,DMPD组多项血糖波动指标如日内血糖波动标准差(P<0.001)、变异系数(P=0.009)和日间血糖平均绝对差(P=0.043)均显著低于DM组。DMPD和DM组均表现为凌晨血糖低,餐后高血糖特点,但DMPD组凌晨血糖低谷明显高于DM组(P<0.001)。结论腹膜透析糖尿病患者血糖波动显著小于平均血糖水平匹配的肾功能正常糖尿病患者。

Objective To compare glycemic profile between diabetic patients receiving peritoneal dialysis and diabetic patients with normal kidney function,and to investigate the impact of peritoneal dialysis on glycemic control through continuous glucose monitor system(CGMS).Methods 19 diabetic patients with end-stage renal disease receiving regular peritoneal dialysis(DMPD group)and 8 patients with non-diabetic nephropathy receiving regular peritoneal dialysis(PD group)were randomly selected and matched with 20 diabetic patients with normal kidney function(DM group)based on age,gender and 72 hours mean glucose.CGMS were applied on all patients for 72 hours.Glycemic variability parameters were compared among the three groups.Results Peritoneal transport function was positively correlated with mean glucose,glucose standard deviation and mean amplitude of glycemic excursion.Compared with PD group,multiple variation parameters,such as intraday glycemic standard deviation(P<0.001),covariant efficiency(P=0.009)and mean of daily difference(P=0.043),were significantly lower in DMPD group.Though both DMPD and DM group exhibited profile as trough in wee hours and post-prandial hyperglycemia,DMPD had higher glycemic level in wee hours(P<0.001).Conclusion Diabetic patients with end-stage renal disease receiving regular peritoneal dialysis have smaller glucose variability than diabetic patients with normal renal function.