重症糖尿病患者宽松血糖控制治疗的疗效研究

The effect of blood glucose control in patients with severe diabetes

目的 评价宽松血糖浓度目标是否可以降低重症糖尿病患者低血糖发生率和血糖变异性.方法 选取在我院ICU治疗的156例Ⅱ型糖尿病患者,将患者随机分为两组,一组患者进行强化血糖控制治疗（强化组,n=78）,即任意时间血糖浓度≥10 mmol/L,给予患者胰岛素,调整胰岛素用量,将血糖控制在6~10 mmol/L;另一组进行宽松血糖控制治疗（宽松组,n=78）,即任意时间血糖浓度≥14 mmol/L,将血糖控制在10~14 mmol/L.通过计算每例患者的变异系数（CV）来评估血糖变异性,比较两组患者低血糖的发生率与患者预后,采用炎症标志物的血浆浓度、血浆葡萄糖周转率和氧化应激来评估安全性.结果 与强化组比较,宽松组血糖CV[（23.9±7.8）% vs.（33.3±13.9）%,P=0.009]显著下降,宽松组患者绝对低血糖发生率、相对低血糖发生率与低血糖复发率显著降低（均P〈0.05）,两组患者白细胞介素-6、高敏C反应蛋白、1,5-脱水葡萄糖醇与异前列素的血清浓度比较,差异无统计学意义（均P〉0.05）,两组患者ICU病死率、医院病死率与1年病死率比较差异无统计学意义（分别P=0.197,0.853与0.500）.结论 对Ⅱ型糖尿病患者进行宽松的血糖控制可降低血糖变异性,并减少低血糖的患病率.

Objective To evaluate whether the goal of loose blood glucose concentration can reduce the incidence of hypoglycemia and blood glucose variability in critically ill patients with diabetes mellitus.Methods A total of 156 patients with type 2 diabetes mellitus were treated with ICU in our hospital.Patients were randomly divided into two groups, each group of 78 patients.A group of patients underwent intensive glycemic control（intensive group, n=78）, that is, when any time blood glucose concentration≥10 mmol/L, the patient was given insulin to control blood sugar within 6~10 mmol/L.The other group was treated with loose blood glucose control（loose group, n=78）.That is, when any blood glucose concentration≥14 mmol/L, the blood glucose control in 10~14 mmol/L.Blood glucose variability was assessed by calculating the coefficient of variation for each patient.The incidence of hypoglycemia in both groups was compared with the prognosis of the patient.Plasma concentrations of inflammatory markers, plasma glucose turnover, and oxidative stress were used to assess safety.Results Compared with the intensive group, the variation coefficient of blood glucose [（23.9±7.8）% vs.（33.3±13.9）%, P=0.009]was significantly decreased in the loose group.The incidence of absolute hypoglycemia, the incidence of hypoglycemia and the rate of recurrent hypoglycemia were significantly lower in all patients（all P〈0.05）.There was no significant difference between the two groups（P〉0.05）in the levels of Interleukin-6, high-sensitivity C-reactive protein, 1,5-anhydroglucitol and isoamectin（all P〉0.05）.There was no significant difference in ICU mortality, hospital mortality and one-year mortalitybetween the two groups（P=0.197, 0.853 and 0.500）.ConclusionRelaxed blood glucose control in patients with type 2 diabetes can reduce blood glucose variability and reduce the prevalence of hypoglycemia.