糖尿病肾病维持性血液透析患者血糖控制对并发症的影响

The impact of blood glucose on complications in diabetic nephropathy on maintenance hemodialysis

目的探讨血糖对合并糖尿病的维持性血液透析患者的并发症及长期生存率的影响。方法选取1999～2004年上海市杨浦区中心医院肾内科合并糖尿病的维持性血液透析患者55例,根据空腹血糖均值分为3组,A组患者空腹血糖(FPG)<6．1mmol／L,B组6．1mmol／L≤FPG<7．0mmol／L,C组FPG≥7．0mmol／L,观察患者血液透析过程中有无低血糖,病程中心血管并发症发生率、严重感染和脑血管意外,监测生化指标,统计1年及3年生存率。结果A组及C组心血管及感染发生率较大于B组(P<0．05),贫血及低蛋白血症较B组明显(P<0．05),B组的长期生存率有较高的趋势,但差异未达到显著性(P>0．05)。结论维持性血液透析患者的空腹血糖控制在6．1～7．0的范围内,并发症发生率较低。

Objective To investigate the impact of blood glucose on complications and survival rate in diabetic nephropathy on maintenance hemodialysis. Methods Fifty-five cases of diabetic nephropathy on maintenance hemodialysis treated in this hospital in the period of 1999 to 2004 were retrospectively surveyed. Patients were categorized into three groups based on their fasting blood glucose level： group A, 〈6.1mmol/l; group B, 〉6.1 mmol/l and 〈7.0mmol/l; group C, =7.0mmol/l. Cardiovascular and cerebrovascular diseases, severe infections, hypoglycemia and blood biochemistry were monitored. Survival rate were calculated after dialysis for one and three years. Results The incidence rate of cardiovascular diseases, severe infections, anemia and hypoproteinemia was higher in groups A and C than in group B （P 〈0.05）. The one year and three year survival rates were higher in group B, but they had no statistical significance among the three groups （P〉0.05）. Conclusion For the reduction of complications, the fasting blood glucose should be controlled to the range of 6.1-7.0mmol/l in diabetic nephropathy on maintenance hemodialysis.