动态血糖监测系统对老年非糖尿病患者频发低血糖的诊断价值

Value of dynamic glucose monitoring system in the diagnosis of frequent hypoglycemia in elderly non-diabetic patients

目的分析动态血糖监测系统(DGMS)对老年非糖尿病患者频发低血糖的诊断价值,为诊断该病提供方法。方法选择2019年3月—2021年3月在首都医科大学附属北京友谊医院接受诊治的老年非糖尿病低血糖患者101例,根据不同病因分为5组:药物性低血糖(n=37)、胰岛素瘤(n=28)、胰岛素自身免疫综合征(IAS)(n=14)、胰岛细胞增生(n=12)、先天性高胰岛素血症(CHI)(n=10)。5组患者入院后接受5h口服葡萄糖耐量试验、饥饿试验与DGMS,对比3种低血糖诊断情况。结果DGMS监测结果显示,平均血糖:CHI组<胰岛素瘤组、胰岛细胞增生组<药物性低血糖组<IAS组(P<0.05),IAS组最大血糖波动幅度大于其他4组(P<0.05),IAS组血糖>11.1 mmol/L构成比高于药物性低血糖组(P<0.05)。7.8 mmol/L<血糖≤11.1 mmol/L构成比:CHI组<胰岛细胞增生组<胰岛素瘤组<药物性低血糖组<IAS组(P<0.05);3.9 mmol/L<血糖≤7.8 mmol/L构成比:CHI组<IAS组<胰岛素瘤组<药物性低血糖组、胰岛细胞增生组(P<0.05);3.0 mmol/L<血糖≤3.9 mmol/L构成比:药物性低血糖组<IAS组<胰岛细胞增生组<胰岛素瘤组<CHI组(P<0.05);血糖≤3.0 mmol/L构成比:IAS组、药物性低血糖组<胰岛素瘤组、胰岛细胞增生组<CHI组(P<0.05)。5组日间平均血糖高于夜间平均血糖(P<0.05);日间平均血糖:CHI组<药物性低血糖组、胰岛细胞增生组<胰岛素瘤组<IAS组(P<0.05);夜间平均血糖:CHI组<药物性低血糖组、胰岛细胞增生组<胰岛素瘤组<IAS组(P<0.05)。结论DGMS可提高不同病因老年非糖尿病患者低血糖诊出率,并为确诊病因提供有参考意义的临床数据。

Objective To analyze the value of dynamic glucose monitoring system(DGMS)in the diagnosis of frequent hypoglycemia in elderly non-diabetic patients,and to provide a method for diagnosis of the disease.Methods A total of 101 elderly non-diabetic hypoglycemic patients who were diagnosed and treated in Beijing Friendship Hospital Affiliated to Capital Medical University from March 2019 to March 2021 were selected.According to different etiologies,they were divided into drug-induced hypoglycemia group(n=37),insulinoma group(n=28),insulin autoimmune syndrome(IAS)group(n=14),islet cell hyperplasia group(n=12),congenital hyperinsulinemia group(CHI)(n=10).All patients received 5 h oral glucose tolerance test,starvation test and DGMS after admission,and the diagnostic results of three methods for hypoglycemia were compared.Results DGMS monitoring results showed that the mean blood glucose:CHI group<insulinoma group,islet cell hyperplasia group<drug-induced hypoglycemia group<IAS group(P<0.05).The maximum fluctuation range of blood glucose in IAS group was greater than that in the other four groups(P<0.05),and the composition ratio of blood glucose>11.1 mmol/L in IAS group was higher than that in drug-induced hypoglycemia group(P<0.05).The composition ratio of 7.8 mmol/L<blood glucose;11.1 mmol/L:CHI group<islet cell hyperplasia group<insulinoma group<drug-induced hypoglycemia group<IAS group(P<0.05);the composition ratio of 3.9 mmol/L<blood glucose;7.8 mmol/L:CHI group<IAS group<insulinoma group<drug-induced hypoglycemia group,islet cell hyperplasia group(P<0.05);the composition ratio of 3.0 mmol/L<blood glucose;3.9 mmol/L:drug-induced hypoglycemia group<IAS group<islet cell hyperplasia group<insulinoma group<CHI group(P<0.05);the composition ratio of blood glucose;3.0 mmol/L:IAS group,drug-induced hypoglycemia group<insulinoma group,islet cell hyperplasia group<CHI group(P<0.05).Daytime mean blood glucose was higher than nighttime mean blood glucose in 5 groups(P<0.05).Mean daytime blood glucose:CHI group<drug-induced hypoglycemia group,islet cell hyperplasia group<insulinoma group<IAS group(P<0.05);mean nighttime blood glucose:CHI group<drug-induced hypoglycemia group,islet cell hyperplasia group<insulinoma group<IAS group(P<0.05)Conclusion DGMS can improve the diagnosis rate of hypoglycemia in elderly non-diabetic patients with different etiologies,and provide reference clinical data for the diagnosis of etiology.