生长抑素致急性胰腺炎患者低血糖的临床特征与影响因素分析

Clinical characteristics and influencing factors of hypoglycemia induced by somatostatin in acute pancreatitis patients

目的探讨生长抑素致急性胰腺炎(AP)患者低血糖的发生情况、临床特征及影响因素。方法收集2019年5月1日至2023年9月10日在阜阳市人民医院接受生长抑素治疗的AP患者电子病历,从中筛选出生长抑素导致低血糖的患者,对这些患者的临床特征进行回顾性分析。按照是否发生生长抑素相关低血糖将患者分为低血糖组和无低血糖组,比较2组患者的临床特征。应用多因素logistic回归方法分析生长抑素相关低血糖发生的影响因素。效应量为比值比(OR)及其95%置信区间(CI)。结果纳入分析的患者共353例,其中33例被判定为生长抑素相关低血糖,发生率为9.3%。33例患者中男性22例(66.7%)、女性11例(33.3%),年龄(52±20)岁。33例患者共发生低血糖事件66例次,其中17例(51.5%)为多次发作(≥2次)。66例次低血糖事件的中位血糖为2.7 mmol/L,范围1.8~3.8 mmol/L。30例(90.9%)患者低血糖发生于生长抑素治疗期间(共56例次),首次发生的生长抑素中位疗程为3(2,4)d,39.3%(22/56)和21.4%(12/56)的低血糖发作时间段分别为前夜(18:00~23:59)和后夜(0:00~5:59)。3例患者(9.1%)的低血糖发生于生长抑素停药后4~7 d(共10例次)。多因素logistic回归分析显示,基础疾病有糖尿病是AP患者生长抑素相关低血糖发生的独立危险因素(OR=6.574,95%CI:1.911~22.430,P=0.003);而高血清总蛋白和肠外营养支持治疗是AP患者生长抑素相关低血糖发生的保护因素(OR=0.940,95%CI:0.885~0.998,P=0.043;OR=0.405,95%CI:0.166~0.990,P=0.047)。结论AP患者应用生长抑素治疗期间至停药后1周内均应警惕低血糖的发生,尤其在夜间。患有糖尿病、低血清总蛋白是AP患者生长抑素相关低血糖发生的独立危险因素,而肠外营养支持治疗是生长抑素相关低血糖发生的保护因素。

Objective To explore the occurrence,clinical characteristics and influencing factors of hypoglycemia induced by somatostatin in patients with acute pancreatitis(AP).Methods The electronic medical records of AP patients treated with somatostatin in Fuyang people’s Hospital from May 1,2019 to September 10,2023 were collected.Patients with hypoglycemia caused by somatostatin were screened out,and the clinical characteristics of these patients were retrospectively analyzed.Patients were divided into hypoglycemia group and non-hypoglycemia group according to whether somatostatin-related hypoglycemia occurred.The clinical characteristics in patients of the 2 groups were compared and the influencing factors of somatostatin related hypoglycemia were analyzed using multivariate logistic regression method.The effect sizes were the odds ratio(OR)and its 95%confidence interval(CI).Results A total of 353 patients were included in the analysis and 33 patients were diagnosed with somatostatin-related hypoglycemia,with an incidence of 9.3%.Of the 33 patients,22(66.7%)were male and 11(33.3%)were female,aged(52±20)years.Thirty-three patients experienced a total of 66 hypoglycemic events,of which 17(51.5%)had multiple episodes(≥2).The median blood glucose of 66 hypoglycemic events was 2.7 mmol/L,ranging from 1.8 to 3.8 mmol/L.Fifty-six times of hypoglycemia occurred during somatostatin treatment in 30 patients(90.9%),with a median time of 3(2,4)days for the first occurrence of somatostatin,and 39.3%(22/56)and 21.4%(12/56)of hypoglycemia episodes occurred in the first half of the night(18:00 to 23:59)and the second half of the night(0:00 to 5:59),respectively.Ten times of hypoglycemia occurred 4-7 days after somatostatin withdrawal in 3 patients(9.1%).Multivariate logistic regression analysis showed that diabetes mellitus was an independent risk factor for the occurrence of somatostatin related hypoglycemia in patients with AP(OR=6.574,95%CI:1.911-22.430,P=0.003),while high serum total protein and parenteral nutrition support were protective factors(OR=0.940,95%CI:0.885-0.998,P=0.043;OR=0.405,95%CI:0.166-0.990,P=0.047).Conclusions Patients with AP should be alert to the occurrence of hypoglycemia during somatostatin treatment and within 1 week after drug withdrawal,especially at night.Diabetes mellitus and low serum total protein were independent risk factors for the occurrence of somatostatin-related hypoglycemia in patients with AP,while parenteral nutrition support was a protective factor.