胰岛素强化治疗糖尿病住院患者低血糖发生率及其危险因素分析

Hypoglycemic incidence rate and risk factors in hospitalized diabetes paients treated with intensive insulin therapy

目的探讨胰岛素强化治疗糖尿病住院患者低血糖发生率及其相关危险因素。方法将糖尿病患者354例分为持续皮下胰岛素注射(CSII)组220例和多次皮下胰岛素注射(MSII)组134例。收集病史,检测临床指标,统计低血糖发生率,分析低血糖相关因素。结果低血糖发生率51.13%。低血糖组与无低血糖组年龄[(54.4±14.3)vs(51.2±14.4)岁,P<0.05]、BMI[(23.3±3.6)vs(25.4±3.6)kg/m2,P<0.01]、住院时间[(14.1±9.1)vs(10.8±6.4)d,P<0.01]、血肌酐(Scr)[(104.9±118.6)vs(72.8±48.9)μmol/L,P<0.01]、血糖达标时间[(11.8±7.3)vs(9.2±5.9)d,P<0.01]、糖尿病并发症(冠心病、糖尿病慢性肾脏疾病)和代谢异常因素(脂肪肝、脂代谢异常)比较差异有统计学意义。Logistic多元逐步回归分析显示,BMI、Scr、脂肪肝和脂代谢异常进入方程。结论胰岛素强化治疗糖尿病住院患者低血糖发生率高。低BMI、高Scr为其独立危险因素,脂肪肝、脂代谢异常为其保护性因素。

Objective To investigate the hypoglycemic incidence and risk factors for hospitalized diabetes patients treated with intensive insulin therapy. Methods 354 case of diabetes patients were selected and divided into continuous subcutaneous insulin infusion （CSII） group and multiple subcutaneous insulin injection （MSII） group. Clinical data, blood glucose level, diabetic complications, chronic co- morbidities and metabolic syndromes were compared between the two groups. Logistic regression analysis revealed the risk factors for total hypoglycemia. Results The incidence of hypoglycemia was 51.13%. There were significant de{ferences in age[（54.4±14.3）vs（51.2± 14.4）year, P〈0.05], BMI（23.3±3.6）vs（25.4 ± 3.6）kg/m2 , P〈0.01）, lenth of stayE（14. 1 ± 9.1）vs （10.8±6.4） d, P〈0.01], serum creatinineE（104.9±118.6）vs（72.8±48.9）/,mol/L,P〈0.01], the time of blood glucose[-（11.8±7.3）vs （9.2±5.9）d,P〈0.01], diabetic complications（coronary artery disease, chronic kidney disease in diabetes） and metabolic disorder factors （fatty liver, dyslipidemia） between hypoglycemia and non-hypoglycemia groups. According to the logistic regression analysis, BMI, serum creatinine, fatty liver and dyslipidemia were entered the equation- Condttsion The incidence d hypoglycemia in hospitalized diabetes paients treated with intensive insulin therapy was high. Low BMI, high serum creatinine were independent risk factors, fatty liver and dyslipidemia were protective factors.