血液透析的终末期糖尿病肾病患者血糖波动的临床研究探寻

Clinical Research on Blood Glucose Fluctuation in End-stage Diabetic Nephropathy Patients on Hemodialysis

目的分析血液透析(HD)对于终末期糖尿病肾病(ESRD)患者血糖波动的影响。方法选取2019年1月—2021年1月该院收治的40例ESRD接受HD治疗的患者作为A组;选取同期入院治疗的ESRD未接受HD治疗的患者作为B组。为其进行血糖检验,对比血糖水平、不良事件发生率和低血糖的危险因素。结果A组患者透析后的空腹血糖(FBG)水平为(6.06±0.54)mmol/L,B组为(4.88±0.51)mmol/L,差异有统计学意义(t=10.048,P<0.05);A组患者透析后的早餐后血糖水平为(9.35±0.81)mmol/L,B组为(6.67±0.75)mmol/L,差异有统计学意义(t=15.354,P<0.05);A组患者透析后的午餐后血糖水平为(10.21±1.25)mmol/L,B组为(6.24±1.08)mmol/L,差异有统计学意义(t=15.199,P<0.05);A组患者透析后的晚餐后血糖水平为(9.77±0.62)mmol/L,B组为(6.67±0.51)mmol/L,差异有统计学意义(t=24.422,P<0.05);A组患者透析后的睡前血糖水平为(7.72±0.95)mmol/L,B组为(5.28±0.91)mmol/L,差异有统计学意义(t=11.731,P<0.05);A组患者透析后的血肌酐(SCr)水平为(280.65±20.21)μmol/L,B组为(291.32±21.62)μmol/L,差异有统计学意义(t=2.280,P<0.05);A组患者透析后的血尿素氮(BUN)水平为(12.35±1.58)mmol/L,B组水平为(14.05±1.41)mmol/L,差异有统计学意义(t=5.077,P<0.05)。A组患者的不良事件发生率为45.0%,B组为20.0%,差异有统计学意义(χ^(2)=5.698,P<0.05)。单因素分析发现年龄、病程和是否使用胰岛素是ESRD患者发生低血糖的危险因素,多因素回归分析发现,年龄≥60岁和使用胰岛素是低血糖发病的独立因素。结论ESRD患者在进行HD治疗期间伴有明显的血糖波动,且不良事件发生率更高,低血糖的发生原因与患者年龄和使用胰岛素有关。

Objective To analyze the effect of hemodialysis(HD)on blood glucose fluctuations in patients with end-stage diabetic nephropathy(ESRD).Methods 40 ESRD patients who were admitted to the hospital between January 2019 and January 2021 who received HD treatment were selected as the subjects of group A,and patients with ESRD who were admitted to the hospital during the same period who did not receive HD treatment were selected as the subjects of group B,and their blood glucose was tested,compared blood glucose levels,adverse events and risk factors for hypoglycemia.Results The fasting blood glucose(FBG)level of patients in group A after dialysis was(6.06±0.54)mmol/L,group B was(4.88±0.51)mmol/L,the difference was statistically significant(t=10.048,P<0.05);the level of patients in group A after dialysis of the blood glucose level after breakfast was(9.35±0.81)mmol/L,group B was(6.67±0.75)mmol/L,the difference was statistically significant(t=15.354,P<0.05);the blood glucose level after lunch after dialysis in group A was(10.21±1.25)mmol/L,group B was(6.24±1.08)mmol/L,the difference was statistically significant(t=15.199,P<0.05);the blood glucose level after dinner after dialysis in group A was(9.77±0.62)mmol/L,group B was(6.67±0.51)mmol/L,the difference was statistically significant(t=24.422,P<0.05);the blood glucose level before bedtime after dialysis in group A was(7.72±0.95)mmol/L,group B was(5.28±0.91)mmol/L,the difference was statistically significant(t=11.731,P<0.05);the blood creatinine(SCr)level of patients in group A after dialysis was(280.65±20.21)μmol/L,group B was(291.32±21.62)μmol/L,the difference was statistically significant(t=2.280,P<0.05);the blood urea nitrogen(BUN)level after dialysis in group A was(12.35±1.58)mmol/L,and the level in group B was(14.05±1.41)mmol/L,the difference was statistically significant(t=5.077,P<0.05).The incidence of adverse events in group A was 45.0%,and that in group B was 20.0%,the difference was statistically significant(χ^(2)=5.698,P<0.05).Univariate analysis found that age,course of disease,and whether to use insulin were risk factors for hypoglycemia in ESRD patients.Multivariate regression analysis found that age≥60 years and use of insulin were independent factors for the onset of hypoglycemia.Conclusion ESRD patients have obvious blood glucose fluctuations during HD treatment,and the incidence of adverse events is higher.The cause of hypoglycemia was related to the patient’s age and insulin use.