短期双胍类降糖药治疗对糖尿病患者血乳酸水平的影响

Effects of short-term biguanides treatment for diabetes on the levels of plasma lactic acid

目的：观察短期苯乙双胍和二甲双胍治疗高龄2型糖尿病（DM）患者对血浆乳酸水平的影响。方法：苯乙双胍组为16例高龄（60-74岁）2型DM患者,每日服用苯乙双胍150mg,连续7d;二甲双胍组为16例高龄（60-76岁）2型DM患者,每日服用二甲双胍1.5 g,连续7d。于服药前、服药1-7 d,每日监测血浆乳酸水平的变化。结果：苯乙双胍组服药后血乳酸水平[分别为（2.64±0.74）、（2.76±0.72）、（3.42±1.01）、（3.44±0.78）、（3.67±0.78）、（3.74±0.87）、（3.76±0.86）mmol·L^-1]较服药前水平[（2.32±0.59）mmol·L^-1]显著增高（F=7.833,P=0.000）。二甲双胍组服药前后血浆水平无明显变化（F=0.942,P=0.479）。结论：高龄2型DM患者短期服用苯乙双胍可以引起血浆乳酸水平明显增高,继续服用有发生乳酸酸中毒的倾向。

Objective To observe the changes of plasma lactic acid following short-term phenformin and meltformin treatment in patients with type Ⅱ diabetes. Methods Sixteen patients with type 2 diabetes （aged 60 - 74 years）with oral administration of phenformin 150 mg daily for 7 days） and 16 patients with diabetes （ aged 60 - 76 years） with oral adminstration of melfformin 1.5 g daily for 7 days were included. Plasma lactic acid was measured before the treatment and 1,2,3,4,5,6,7day after the treatment. Results The levels of plasma lactic acid of 0 to 7 days in the phenformin group were（2.32 -0.59）, （2.64 -0.74）, （2.76 -0.72）, （3.42 - 1.01 ）, （3.44 -0.78）, （3.67 -0.78）, （3.74 - 0.87 ） and （3.76 - 0.86 ） mmol·L^-1, respectively. The levels of plasma lactic acid after the treatment were apparently increased compared with those before the treatment （ F = 7. 833, P = 0. 000）. The levels of plasma lactic acid in meltformin were not obviously changed before and after the treatment （ F = 0. 942, P = 0. 479 ）. Conclusions The results reveal that short-term phenformin treatment for older patients with diabetes may lead to the increase of plasma lactic acid or even lactic acidosis when the treatment is prolonged.