糖尿病合并新型冠状病毒感染血糖控制状况对预后影响的研究现状

Research progress of the effect of glycemic control on the prognosis of diabetes with corona virus disease 2019

新型冠状病毒感染(corona virus disease 2019,COVID-19)是由严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)引起的发病率高、传染性强、病情变化快的急性传染性疾病。糖尿病[主要是2型糖尿病(type 2 diabetes mellitus,T2DM)]合并感染COVID-19具有控制困难、并发症多、危重率高、致死率高等特点,其重要原因之一是血糖波动性较大。目前尚无公认的血糖目标范围时间(time in range,TIR),TIR与患者的预后及转归密切相关。血糖变异性参数是预测危重症患者死亡的独立影响因素,监测评估血糖波动是血糖精细化管理的重要内容。本文就T2DM合并COVID-19患者血糖控制状况对预后影响的国内外研究现状进行综述,主要内容包括T2DM合并COVID-19的流行病学现状、主要病理生理机制(如炎症因子风暴、血管紧张素转化酶2表达异常等)、血糖控制目标、住院及出院患者综合管理等,旨在为优化诊治策略、改善预后、降低并发症发生率及病死率等提供理论参考依据。

Corona virus disease 2019(COVID-19)is an acute infectious disease caused by severe acute respiratory syndrome coronavirus 2 with high incidence,strong infectivity and rapid state change.The characteristics of type 2 diabetes mellitus(T2DM)with COVID-19 are uncontrollable,many complications,high critical rate and mortality.Blood glucose variability is one of the main reasons.Currently,there is no accepted time in range(TIR),and TIR is closely associated with prognosis.Glucose variability parameters are independent risk factors for predicting mortality in critical patients.The monitoring of glucose variability is important to realize the fine management of blood glucose.This article reviews the research progress of the effect of glycemic control on the prognosis of T2DM with COVID-19.The main contents include the epidemiological status,major pathophysiological mechanisms(e.g.,cytokine release syndrome,abnormal expression of angiotensin-converting enzyme 2,etc.),glycemic control goals,and scientific management of patients.This review provides a theoretical reference for optimizing the diagnosis and treatment strategy,improving the prognosis,and reducing the incidence of complications and mortality.