短期应用甲基强的松龙对传染性非典型肺炎患者血糖水平的影响

The influence of short-term mythylprednisolone treatm ent on blood glucose in patients with SARS

目的 研究短期应用甲基强的松龙 (mythylprednisolone)治疗传染性非典型肺炎(SARS)对患者空腹血糖和电解质水平的影响。 方法 采用病例回顾性分析的方法 ,对比分析了10 3例SARS患者中 3 9例使用甲基强的松龙在治疗第 1周和停药后 1周空腹血糖和电解质水平的变化。 结果 甲基强的松龙的平均日用量为 (113± 44)mg ,疗程 (12± 4)d ,总剂量达 (13 4 7± 773 )mg时 ,可引起下列变化 :(1)激素治疗 1周时患者空腹血糖比对照组升高约 2 5.5% [(6.4± 2 .5)mmol/L与 (5.1± 1.1)mmol/L ,P <0 .0 0 1]。停用 1周时复查空腹血糖 ,治疗组和对照组间差异无显著意义 [(4 9± 1 8)mmol/L与 (4.9± 0 .9)mmol/L ,P >0 .0 5]。 (2 )激素治疗组中空腹血糖≥ 7.0mmol/L的患者比例显著高于对照组 [(3 9.5%与 11.9% ) (P <0 .0 5) ] ,正常血糖患者的比例明显低于对照组 ,为 55.3 %与 85.5% (P =0 .0 1)。 (3 )停用甲基强的松龙后 ,血钠和氯低于对照组 (P <0 0 5) ,但仍在正常范围以内。 结论 (1)甲基强的松龙治疗的第 1周可以观察到空腹血糖水平上升达2 5.5%。在停药后 1周基本可以恢复到正常水平。 (2 )短期应用糖皮质激素对血清钾。

ObjectiveTo investigate the influence of short-term mythylprednisolone treatment on fasting blood glucose (FBG) and electroly te in patients with SARS.MethodsIn this retrospective study, we analyzed the changes of FBG and electrolyte levels in 39 patients during the first week of mythylprednisolone therapy and one week after stopping the therap y compared with patients without glucocorticoid treatment.ResultsIn the course of (12.1±4) days the mean dosage of mythylprednisolone was ( 113±44) mg/day, and total dosage was (1347±773) mg. The findings were as follo ws:(1)First week in the mythylprednisolone treatment, FBG level, compared with c ontrol group, increased by 25.5%[(6.4±2.5) vs (5.1±1.1)mmol/L,P<0.001 ]. However, there was no significant difference between the two groups one week after stopping mythylprednisolone therapy [(4 9±1 8) vs (4 9±0.9) m mol/L,P>0.05]. (2)The percentage of patients with FBG≥7.0 mmol/L was high er than that in control group (39.5% vs 11.9%, P<0.05) and the rate of pat ients with normal glucose was lower than that in patients without glucocorticoi d 55.3% vs 85 5%(P=0.01). One week after stopping mythylprednisolone th erapy, serum natrium and chloride level decreased markedly (P<0 05), but th e value was still in normal range.Conclusions(1) Compared wi th the control group, the FBG level of patients with mythylprednisolone therapy could increase by 25.5% in the first week of treatment, which could lower to alm ost normal range one week after stopping the treatment. (2) Short-term mythylpr ednisolone treatment had no negative effects on serum potassium, natrium and chl oride level.