不同剂量甲泼尼龙静脉治疗风湿性疾病对血糖影响的前瞻性对照研究

A comparative study on the effect of glucose of different dose methylprednisolone therapies in the treatment of theumatoid diseases

目的 分析静脉应用不同剂量甲泼尼龙对患者治疗最初3 d空腹、早餐后、午餐后及晚餐后血糖的影响.方法 选择2008年5月至2010年9月80例因风湿性疾病需要应用甲泼尼龙静脉点滴治疗的住院患者.所有患者既往均无糖尿病或糖耐量异常史,无口服或静脉应用糖皮质激素病史.甲泼尼龙用量≤80 mg为常规剂量组,共40例;用量≥200 mg为冲击剂量组,共40例.分别检测每例患者入院时空腹、应用甲泼尼龙第1、2、3天的快速血糖值（包括空腹、早餐后、午餐后、晚餐后）,以及应用激素1个月后的空腹血糖值.结果 2组同一时间点的血糖值比较差异无统计学意义（P＞0.05）.80例患者不同时间血糖值的比较结果显示,第1、2、3天的早餐后血糖[分别为（7.99±2.61）、（8.15±3.14）、（7.53±2.59）mmol/L]与这3天的中餐后血糖[分别为（11.80±3.43）、（11.73±3.52）、（10.88±3.63）mmol/L]及晚餐后糖[分别为（10.84±3.59）、（10.86±3.47）、（10.16±3.60）mmol/L]比较,差异均有统计学意义（P＜0.05）;中餐后和晚餐后血糖比较,差异无统计学意义（P＞0.05）.应用甲泼尼龙前和应用1月时的空腹血糖值比较,差异无统计学意义（P＞0.05）.结论 静脉输注甲泼尼龙主要影响中餐及晚餐后血糖.血糖变化未显示出与甲泼尼龙剂量正相关,血糖增高呈一过性.

Objective To investigate the effects of Plasma glucose of different dose methylprednisolone therapies in the treatment of Rheumatoid diseases, including fasting plasma glucose examined and the levels of 2h postprandial glucose. Methods Eighty cases of patients of Rheumatoid diseases who had no Diabetes mellitus and no history of prednisone taking were selected during year 2008 to 2010. All the patients were divided into two groups. The normal dose group were forty patients who received the methylprednisolone （ ≤ 80 mg/day） and the large dose group were also forty patients who received the methylprednisolone（ ≥200 mg/day）. Compared the levels of fasting plasma glucose and the 2 h postprandial glucose in the first three days and the fasting plasma glucose after 1 month. Results The levels of the plasma glucose were not significantly changed in the two groups at the same point. The levels of the plasma glucose after breakfast were significantly different with the levels after lunch and dinner. There was no difference of the plasma glucose between the time before using methylprednisolone and one month. Conclusions The methylprednisolone infusion was mainly effect the plasma glucose levels after lunch and dinner. There was no dose-dependent phenomenon when using the methylprednisolone.