扫描式葡萄糖监测系统在肝移植术后早期受者中的应用研究

Application of flash glucose monitoring system in liver transplant recipients during the early stage after transplantation

目的探讨扫描式葡萄糖监测(FGM)系统在肝移植术后早期受者中的应用。方法选取2019年4月至8月在中山大学附属第一医院器官移植中心行同种异体肝移植术的28例受者,应用FGM系统(美国雅培公司)连续监测组织间液葡萄糖浓度。同时采集受者清晨空腹血液标本,使用全自动生化分析仪检测静脉血糖值作为参考,评估FGM血糖值临床应用的精准性。使用R语言3.6.1软件进行克拉克误差网格分析。采用配对t检验或秩和检验比较术后第1周与第2周FGM结果,采用Pearson相关分析比较FGM血糖值与静脉血糖值的相关性。计算FGM血糖值与静脉血糖值配对数据的平均相对误差绝对值(MARD)和决定系数r 2,比较两种血糖检测方法的一致性。P<0.05为差异有统计学意义。结果28例受者平均佩戴FGM系统时间为(12.5±2.4)d(7~14 d),佩戴期间均未出现过敏、瘙痒、皮肤红斑、青紫和疼痛等不良反应,均未出现传感器脱落。FGM系统佩戴期间,28例受者预估糖化血红蛋白为(6.7±1.7)%,FGM血糖值为(8±3)mmol/L,目标范围内时间为(72±34)%,低于和高于目标范围时间中位数分别为1%和8%。3例受者FGM血糖值全程在目标范围内,23例出现过高于目标范围,14例出现过低于目标范围。肝移植术后第2周FGM血糖值低于术后第1周,分别为(8±3)、(9±4)mmol/L,差异有统计学意义(t=2.4,P<0.05);术后第2周低于目标范围时间中位数(1%)高于术后第1周(0%),差异有统计学意义(z=-2.5,P<0.05)。FGM系统佩戴期间共采集244对空腹FGM血糖值与静脉血糖值,平均血糖值分别为(7±4)、(8±4)mmol/L,二者呈高度正相关(r=0.976,P<0.05)。以全自动生化分析仪检测的静脉血糖值作为参考,克拉克误差网格分析结果示:FGM血糖值有93%(227/244)落在A区,有7%(17/244)落在B区。MARD=9.8%,r 2=0.95。结论FGM系统在肝移植术后早期受者中的临床应用是可行的,与常规间断末梢血糖监测方法相比,可监测到更多血糖异常事件及其持续时间,并及时采取有效治疗措施,控制血糖水平在最佳范围。

Objective To investigate the application of flash glucose monitoring(FGM)system in liver transplant recipients during the early stage after transplantation.Methods Twenty-eight recipients who got allotransplantation of the liver in the Organ Transplant Center of the First Affiliated Hospital of Sun Yat-sen University from April to August 2019 were included in the study.FGM system(Abbott Laboratories,USA)was used to continuously monitor the interstitial fluid glucose concentration,and fasting blood samples of the recipients were collected in the morning,the venous blood glucose value was measured by automatic biochemical analyzer as a reference to evaluate the accuracy of clinical application of FGM blood glucose value.The R language 3.6.1 software was used for Clarke error grid analysis.Paired t-test or rank sum test was used for FGM results at 1 and 2 weeks after liver transplantation.Pearson correlation analysis was used to compare the correlation between FGM blood glucose values and venous blood glucose values.The mean absolute relative difference(MARD)and determination coefficient r 2 of the paired data of FGM blood glucose and intravenous blood glucose were calculated to compare the consistency of the two methods.P<0.05 was considered statistically significant.Results The average wearing time of FGM system in 28 recipients was(12.5±2.4)d(7-14 d),and no adverse reactions such as allergy,itching,skin erythea,cyanosis and pain occurred during wearing,and no sensor shedding occurred.During the wearing of the FGM system,the estimated glycated hemoglobin of 28 recipients was(6.7±1.7)%,the glucose level of FGM was(8±3)mmol/L,and the time within the target range was(72±34)%,with the median time below and above the target range being 1%and 8%,respectively.The FGM blood glucose values of 3 recipients was within the target range throughout the whole process,23 cases were once above the target range,and 14 cases were once below the target range.The blood glucose level of FGM at 2 weeks after transplantation[(8±3)mmol/L]was lower than that at 1 week[(9±4)mmol/L],and the difference was statistically significant(t=2.4,P<0.05).The median time below the target range at 2 weeks after transplantation(1%)was higher than that at 1 week(0%),and the difference was statistically significant(z=-2.5,P<0.05).During wearing the FGM system,244 pairs of fasting FGM blood glucose values and venous blood glucose values were collected,the average blood glucose level was(7±4)and(8±4)mmol/L respectively,showing a highly positive correlation(r=0.976,P<0.05).The results of Clarke error grid analysis showed that 93%(227/244)and 7%(17/244)of FGM blood glucose values were in zone A and B respectively.MARD=9.8%,r 2=0.95.Conclusions The clinical application of FGM system in liver transplant recipients during the early stage after transplantation was feasible.Compared with the conventional intermittent peripheral blood glucose monitoring,more abnormal blood glucose events and their duration could be detected.It could help to take favorable treatment to control glucose levels in the best range.