2型糖尿病患者服用二甲双胍影响血肌酐与乳酸的关系

Effect on the Association of Cr and Lactic Acid in the Patients with Type 2 Diabetes Treating by Metformin

目的探讨肾功正常的高原地区2型糖尿病患者服用二甲双胍后,对血肌酐与乳酸的关系是否产生影响。方法选择肾功能正常的2型糖尿病患者478例,按治疗方案分为A组和B组,A组(262例)是二甲双胍用药组,B组(216例)是二甲双胍未用药组。用酶电极法测定血乳酸水平,比较两组间血乳酸的差异,探讨两组中血肌酐与乳酸之间的关系。结果1、两组间平均血乳酸水平无统计学差异[(1.54±0.73 vs 1.48±0.54)mmol/L,p=0.368]。2、A组共有47例(17.9%)出现高乳酸血症,B组有33例(15.3%),两组间高乳酸血症的发审率无差异(p=0.407)。3、相关分析结果显示,在校正腰围、血红蛋白、年龄、BMI、糖尿病病程后,当A组中肌酐≤90μmol/L时,肌酐与乳酸之间的关系无统计学意义(P﹥0.05),而当肌酐≥91μmol/L时,乳酸水平随即升高(P<0.05);而B组中并未观察到肌酐与乳酸相关。结论肾功能正常的高原地区2型糖尿病患者应用二甲双胍时,需监测乳酸水平,当肌酐≥91μmol/L后,患者发生高乳酸血症的风险增加。

Objective:TTo study the relationship between Cr and lactic acid in type 2 diabetic patients with normal renal function,and the effect of metformin administration on plasma lactic acid.Methods:Totally,blood samples were collected from 478 type 2 diabetes patients with normal renal function.They were divided into A group(262 cases treated with metformin)and B group(216 cases treated without metformin).The difference of lactic acid was compared in the two groups,discussing the relations with Cr.Results:(1)There was no statistica l difference in lactic acid between A group and B group[(1.54±0.73 vs.1.48±0.54)mmol/L,p=0.368].(2)There was no statistical difference in the incidence rate of hyperlactacidemia between A group and B group(17.9%vs.15.3%).(3)The correlation analysis showed that Cr and lactic acid in A group had no statistical significant difference when Cr was under 90μmol/L(P﹥0.05).However,lactic acid increased with Cr higher when Cr was over 90μmol/L(P<0.05).(3)Significant changes in Cr and lactic acid were not observed in B group.Conclusions:The incidence of hyperlactacidemia may increase when Cr level reaches 91μmol/L.Therefore,lactic acid should be monitored when type 2 diabetic patients treating by metformin.