糖皮质激素治疗结缔组织病致低血糖症临床分析

Clinical Analysis of Hypoglycemia Induced by Glucocorticoid in Treatment of Connective Tissue Disease

目的 观察结缔组织病（connective tissue disease,ClTD）予糖皮质激素治疗后致血糖降低的临床特征.方法 对我院应用糖皮质激素后出现低血糖的28例CTD的临床资料进行回顾性分析.结果 28例CTD中系统性红斑狼疮19例,占67.86％；女性多于男性（男∶女=1∶8.3）；发病年龄较轻,15 ～30岁19例,占67.86％；病程及累积应用糖皮质激素时间以24～60个月例数最多,分别占42.86％、32.14％；糖皮质激素累积剂量以5000 ～ 10 000 mg例数最多,占46.43％.28例出现低血糖时均无低血糖症状,血糖平均3.2 mmol/L,予糖皮质激素规律减量后,26例血糖恢复正常,余2例未恢复,继续糖皮质激素原方案治疗、规律减量,仍随访中.结论 患CTD的低龄女性患者长期、大剂量应用糖皮质激素后易诱发低血糖,治疗中需及时调整糖皮质激素用量以控制低血糖的发生.

Objective To observe clinical characteristics of hypoglycemia induced by glucocorticoid in treatment of connective tissue disease （CTD）.Methods Clinical data of 28 patients with hypoglycemia induced by glucocorticoid in treatment of CTD in our hospital was retrospectively analyzed.Results There were 19 patients （67.86％） with systemic lupus erythematosus in the 28 patients with CTD; the number of females was larger than that of males （male∶ female =1∶ 8.3） ; patients aged at 15-30 at onset accounted for 67.86％ （19 cases）; the longest course of disease and cumulative time of using glucocorticoid lasted 24-60 months,and accounted for 42.86％ and 32.14％ respectively; the amount of the largest cumulative dose of glucocorticoids was 5000-10 000 mg,and accounted for 46.43％.No hypoglycemia symptoms occurred when the 28 patients had hypoglycemia,and average blood glucose was 3.2 mmol/L.The blood glucose in 26 patients returned to normal after regular reduction treatment with glucocorticoid;but the other 2 patients did not recover,and then same glucocorticoid therapy was continued with regular reduction,and follow-up is still under way.Conclusion Long-term and high-dose glucocorticoids to younger female patients with CTD may induce hypoglycemia,so glucocorticoid dosage should be adjusted in time to control the incidence of hypoglycemia.