二甲双胍对2型糖尿病患者合并高乳酸血症的影响

Impact of metformin on hyperlactatemia in patients with type 2 diabetes mellitus

目的探讨二甲双胍对2型糖尿病患者合并高乳酸血症的影响。方法回顾性分析2018年10月至2020年9月于首都医科大学附属北京同仁医院住院治疗的247例2型糖尿病患者的临床资料。根据入院前是否已连续服用二甲双胍2周以上,将患者分为二甲双胍组(136例)和非二甲双胍组(111例)。收集患者基线资料及血乳酸、血糖、肾功能、血脂、肝功能等指标。比较2组患者及不同性别患者之间上述资料。采用多因素Logistic回归模型分析2型糖尿病患者合并高乳酸血症的危险因素。结果二甲双胍组患者糖尿病病程长于非二甲双胍组,高血压病比例、体重指数均高于非二甲双胍组,糖化血红蛋白、空腹血糖、低密度脂蛋白胆固醇(LDL-C)水平及高乳酸血症比例均低于非二甲双胍组[(8.1±1.8)%比(9.1±2.3)%,(7.7±2.6)mmol/L比(9.1±5.7)mmol/L、(2.4±0.9)mmol/L比(2.6±0.9)mmol/L、78.7%(107/136)比83.8%(93/111)],差异均有统计学意义(均P<0.05)。共200例患者合并高乳酸血症,其中3例(1.2%)患者血乳酸>5 mmol/L,但均未发生乳酸酸中毒。女性2型糖尿病患者年龄、总胆固醇、LDL-C、高密度脂蛋白胆固醇、血乳酸水平及高乳酸血症比例均高于男性患者,体重指数、腰臀比、尿微量白蛋白/肌酐比值、血肌酐及三酰甘油水平均低于男性患者,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,应用二甲双胍与2型糖尿病患者合并高乳酸血症无关(比值比=0.899,95%置信区间:0.440~1.837,P=0.770),而女性(比值比=2.846,95%置信区间:1.258~6.438,P=0.012)、空腹血糖(比值比=1.264,95%置信区间:1.074~1.487,P=0.005)为2型糖尿病患者合并高乳酸血症的独立危险因素。结论2型糖尿病患者易出现高乳酸血症,应用二甲双胍与高乳酸血症的发生无关,女性、空腹血糖控制不佳患者合并高乳酸血症的风险更高。

Objective To investigate the impact of metformin on hyperlactatemia in patients with type 2 diabetes mellitus.Methods Clinical data of 247 patients with type 2 diabetes mellitus were retrospectively analyzed,who were admitted to Beijing Tongren Hospital,Capital Medical University from October 2018 to September 2020.Patients were divided into metformin group(136 cases)and non-metformin group(111 cases)according to whether they had taken metformin continuously more than 2 weeks.The baseline data and indicators such as blood lactic acid,blood glucose,renal function,blood lipid and liver function were collected,and those were compared between the two groups and between different gender.Multivariate Logistic regression model was used to analyze the risk factors for hyperlactatemia in patients with type 2 diabetes mellitus.Results The course of diabetes mellitus in metformin group was longer than that in non-metformin group,rate of hypertension and body mass index were higher than those in non-metformin group,and levels of glycosylated hemoglobin,fasting blood glucose,low-density lipoprotein cholesterol(LDL-C)and rate of hyperlactatemia were lower than those in non-metformin group[(8.1±1.8)%vs(9.1±2.3)%,(7.7±2.6)mmol/L vs(9.1±5.7)mmol/L,(2.4±0.9)mmol/L vs(2.6±0.9)mmol/L,78.7%(107/136)vs 83.8%(93/111)](all P<0.05).There were 200 patients complicated with hyperlactatemia,including 3 patients(1.2%)with blood lactic acid>5 mmol/L,and no lactic acidosis was found.The age,levels of total cholesterol,LDL-C,high-density lipoprotein cholesterol,and rate of hyperlactatemia in female diabetic patients were higher than those in male diabetic patients,while body mass index,waist hip ratio,urinary microalbumin/creatinine ratio,levels of serum creatinine and triacylglycerol were lower than those in male diabetic patients(all P<0.05).Multivariate Logistic regression analysis showed that there were no relationship between metformin and hyperlactatemia in patients with type 2 diabetes mellitus(odds ratio=0.899,95%confidence interval:0.440-1.837,P=0.770),while female(odds ratio=2.846,95%confidence interval:1.258-6.438,P=0.012)and fasting blood glucose(odds ratio=1.264,95%confidence interval:1.074-1.487,P=0.005)were independent risk factors for complicating with hyperlactatemia.Conclusions Hyperlactatemia is common in patients with type 2 diabetes mellitus.Metformin is not associated with hyperlactatemia,and patients who were female and have poor fasting glucose control have higher risk for complicating with hyperlactatemia.