2型糖尿病患者血乳酸水平的性别差异及二甲双胍对其的影响

Gender difference of plasma lactate levels in patients with type 2 diabetes and the effect of metformin

目的探讨肝肾功能正常的2型糖尿病患者血乳酸水平的性别差异，以及二甲双胍对此性别差异的影响。方法选择肝肾功能正常的2型糖尿病住院患者1021例，分为二甲双胍用药组（男213例，女210例）和二甲双胍未用药组（男299例，女299例）。用酶电极法测定空腹血乳酸水平，同时测定血糖、肝肾功能等指标。分析血乳酸的相关因素，并比较用药组、非用药组和总组以及各肌酐、谷丙转氨酶（ALT）亚组和年龄亚组（〈45岁、45～55岁、〉55岁）的不同性别的血乳酸水平。结果二甲双胍用药组的血乳酸水平明显高于未用药组[（1．32±0．53对1．14±0．49）mmol／L，P〈0．01]，其中共61例患者存在高乳酸血症，但未出现乳酸酸中毒。Spearman相关分析显示，除肌酐、ALT外，血乳酸水平还与性别、二甲双胍及体重指数（BMI）呈显著正相关（P〈0．01）。多因素logistic回归分析进一步表明，性别、肌酐、ALT及二甲双胍是发生高乳酸血症的独立相关因素。在总组、用药组及未用药组中女性的血乳酸水平均显著高于男性（均P〈0．05）。与男性相比，在不同的肌酐和ALT亚组，女性的血乳酸水平较高；在各年龄亚组女性的血乳酸水平均高于男性，以〈45岁亚组为著（P=0．021）。结论2型糖尿病患者血乳酸水平具有性别差异，二甲双胍对不同性别的2型糖尿病患者血乳酸水平影响不同，女性，尤其是绝经期前女性的血乳酸更容易升高。

Objective To investigate the gender difference of the plasma lactic acid（LA） levels in type 2 diabetics with normal renal and hepatic function, and the effect of metformin on LA levels in the difference gender. Methods A total of 1 021 type 2 diabetic inpatients with normal renal and hepatic functions were collected, including metformin treatment group （ 213 males and 210 females ） and mefformin non-treatment group （299 males and 299 females ）. LA was measured with enzyme-electrode assay. Fasting plasma glucose （ FPG ） , creatinine（Cr）, and alanine aminotransferase （ALT）levels were determined. Results LA level in metformin treatment group was significantly higher than that in metformin non-treatment group E （1.32±0.53 vs 1.14±0.49） mmoL/L,P〈0. 01 ], and 61 cases had hyperlactacidemia but no lactic acidosis was found. Spearman correlation analysis showed that LA level was positively associated with gender, metformin, and body mass index （ BMI ） apart from Cr and ALT（ P〈0.01 ）. Multivariate logistic regression analysis showed that gender, Cr, ALT, and metformin were independent correlated factors of hyperlactacidemia. LA levels in females were higher than those of males in the whole group and two groups treated or not treated with metformin （ all P〈0.05 ）. LA levels in females were higher compared to male in Cr and ALT subgroups, as well as age subgroups, especially with age younger than 45 years old （ P = 0. 021 ）. Conclusions There is gender difference of lactate level in diabetic patients, and the effect of metformin on the plasma lactate levels of different gender is varied. The plasma LA level in females, especially those approaching menopause, are prone to hoist.