非霍奇金淋巴瘤CHOP样方案化疗后继发类固醇糖尿病的相关危险因素分析

Risk factors for glucocorticoid-induced diabetes mellitus in non-Hodgkin lymphoma after CHOP-like chemotherapy:analysis of 102 cases

目的探讨非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)患者经CHOP样方案化疗后继发类固醇糖尿病(glucocorticoid-induced diabetes mellitus,GIDM)的临床特点及相关危险因素。方法收集2015年1月至2019年3月在本院血液肿瘤科行CHOP样方案化疗的非霍奇金淋巴瘤患者102例,根据美国糖尿病协会的标准诊断糖尿病,并排除已知糖尿病病史及空腹血糖受损病史的患者。观察治疗过程中GIDM的发生情况及临床特点,单因素及多因素分析继发GIDM的相关危险因素。结果102例患者中有44例(43.1%)发生GIDM,发生GIDM的患者疗效较未发生GIDM患者差(P<0.05)。单因素分析发现,年龄≥60岁、糖化血红蛋白(HbA1c)水平≥6.1%、入院时有高血压或既往有高血压病史、高甘油三酯血症、性别(女性)、空腹血糖≥5.0 mmol/L为GIDM的危险因素(P<0.05);多因素分析结果提示年龄≥60岁、空腹血糖≥5.0 mmol/L、糖化血红蛋白≥6.1%、高甘油三酯血症、高血压病史是非霍奇金淋巴瘤CHOP样方案化疗继发GIDM的独立危险因素。结论年龄较大、血糖偏高以及合并血脂、血压异常的非霍奇金淋巴瘤患者在CHOP样方案化疗期间容易发生GIDM。

Objective To investigate the clinical characteristics and related risk factors of glucocorticoid-induced diabetes mellitus(GIDM)in the patients with non-Hodgkin lymphoma(NHL)who were treated with CHOP(doxorubicin,cyclophosphamide,vincristine,prednisone)-like chemotherapy.Methods Clinical data of 102 NHL patients undergoing CHOP-like chemotherapy in our department from January 2015 to March 2019 were collected in this study.After the patients with a known history of DM and impaired fasting glucose were excluded,diagnosis of DM was made according to the American Diabetes Association’s criteria.The incidence and clinical characteristics of GIDM were observed.The risk factors of secondary GIDM were analyzed by univariate and multivariate analysis.Results Forty-four out of 102 patients(43.1%)developed GIDM,and the chemotherapy efficacy in the GIDM patients was worse than that of non-GIDM patients(P<0.05).Univariate analysis indicated that age≥60 years,female,glycated hemoglobin(HbA1 c)level≥6.1%,hypertension at admission or history of hypertension,hypertriglyceridemia,and fasting plasma glucose(FPG)level≥5.0 mmol/L were high risk factors for GIDM(P<0.05).Moreover,multivariate analysis revealed that age≥60 years,FPG level≥5.0 mmol/L,HbA1 c level≥6.1%,hypertriglyceridemia and history of hypertension were independent risk factors of GIDM.Conclusion NHL patients with older age,higher blood glucose,and accompanied with abnormal blood lipid and blood pressure are more likely to develop GIDM during CHOP-like chemotherapy.