基于倾向性评分匹配的老年患者低血糖危险因素分析

Analysis of risk factors of hypoglycemia in elderly patients basedupon propensity score matching

目的:分析老年患者低血糖的相关危险因素,为降低老年患者特别是老年非糖尿病患者低血糖风险提供依据。方法:纳入2018年1月至2019年12月合肥市第三人民医院住院的老年患者病例合计17 132例,低血糖组47例,非低血糖组17 085例。运用倾向性评分匹配对低血糖组和非低血糖组进行1∶1匹配。匹配后进行单因素分析后,采用Logistic回归方法分析老年患者低血糖的危险因素。结果:倾向性评分匹配成功44对病例,单因素分析显示用药种数、糖尿病、危重症、激素、喹诺酮类抗菌药物、肝功能异常等在两组之间的差异结果有统计学意义(P<0.05)。Logistic回归分析结果显示,老年患者低血糖的危险因素为喹诺酮类抗菌药物(OR=3.361,95%CI:1.122~10.072,P<0.05)和肝功能异常(OR=8.671,95%CI:1.439~52.243,P<0.05)。结论:喹诺酮类抗菌药物和肝功能异常为老年患者低血糖的危险因素,激素对老年患者低血糖的影响需进一步研究。对于有肝功能损伤等危险因素的老年患者,在使用对血糖有影响的非降糖药物时,要密切关注低血糖的发生风险。

OBJECTIVE To explore the risk factors of hypoglycemia so as to provide rationales for lowering the risk of hypoglycemia in elderly patients, especially in non-diabetics.METHODS A total of 17,132 elderly patients were recruited and divided into two groups of hypoglycemia(n=47)and non-hypoglycemia(n=17 085).Both groups were matched by propensity score matching(PSM).After univariate analysis, the risk factors of hypoglycemia were analyzed by Logistic regression. RESULTS Forty-four pairs of cases were successfully matched by PSM.Univariate analysis revealed that the inter-group differences of drug varieties, diabetes mellitus, critical illness, glucocorticoids, quinolone antibiotics and liver dysfunction were statistically significant.And multivariate Logistic regression analysis indicated that quinolone antibiotics(OR=3.361,5%CI:1.122-10.072,P<0.05)and liver dysfunction(OR=8.671,95%CI:1.439-52.243,P<0.05)were risk factors of hypoglycemia. CONCLUSION The risk factors of hypoglycemia in elderly patients are quinolone antibiotics and liver dysfunction.And the effect of glucocorticoid on hypoglycemia in elderly patients should be further investigated.Clinicians should pay more attention to the risk factors of liver dysfunction, malnutrition and non-antidiabetic agents for hypoglycemia in elderly patients.