标题：糖尿病患者应用糖皮质激素后24 h血糖波动监测的意义

      作者：史丽 1，谷君 1，许峥嵘 1，任卫东 1，张志英 1，董运成 1，袁小飞 2，杨金良 3，陈雷刚 4，张丽茜 1    (河北北方学院附属第一医院内分泌科 1、血液科 2、风湿免疫科 3、皮肤科 4，河北 张家口 075000)

      卷次： 2017年28卷10期

      【摘要】 目的 观察 2型糖尿病患者实施不同类型糖皮质激素治疗后的 24 h血糖波动特点，为 2型糖尿病患者出现的高血糖进行早期监测和进一步治疗提供依据。方法 选取 2014年 3月至 2016年 3月来我院皮肤科、内分泌科、风湿免疫科、血液病科就诊的糖尿病患者共 60例，所有入选患者均接受糖皮质激素治疗，按治疗方式的不同分为三组，每组各 20例。其中DM1组静滴甲强龙 40 mg，DM2组静滴地塞米松 10 mg，DM3组一次口服强的松 30 mg；所有患者均连续治疗 6 d。对三组患者分别行 3 d动态血糖监测，比较其日间血糖平均绝对差 (MODD)、日内平均血糖波动幅度 (MAGE)、全天血糖标准差 (SDBG)、平均餐后血糖波动幅度(MPPGE)等动态血糖参数的变化。同时在患者行 3 d动态血糖监测的第 2天清晨采集患者空腹静脉血，监测其血清中糖化血红蛋白(HbA1c)。同时，比较三组患者的血糖漂移情况，包括低血糖时间比率、高血糖时间比率、血糖波动系数。结果 DM2组患者的HbA1c、MAGE、SDBG、MPPGE水平均高于DM3组和DM1组，而DM3组的HbA1c、MAGE、SDBG、MPPGE水平均高于DM1组，差异均有显著统计学意义(P<0.01)，但三组患者的MODD水平比较差异无统计学意义(P>0.05)；DM1组患者的高血糖时间比率为(17.35±4.27)%，血糖波动系数为(2.52±1.22)；DM2组患者的高血糖时间比率为(26.30±6.30)%，血糖波动系数为(3.98±1.57)；DM3组患者的高血糖时间比率(20.29±4.03)%、血糖波动系数(3.31±1.17)；由此可知DM2组患者的高血糖时间比率、血糖波动系数显著高于DM1组及DM3组，差异均有统计学意义(P<0.05)。DM1组、DM2组、DM3组三组患者的低血糖时间比率分别为(2.60±1.42)%、(6.61±2.07)%、(3.87±1.92)%，故低血糖时间比率由低到高依次为DM1组、DM3组、DM2组，其中DM2组患者的低血糖时间比率最高，各组间比较差异均有统计学意义(P<0.05)。结论 应用糖皮质激素治疗糖尿病患者除全程常规监测HbA1c外，还应动态监测血糖，以便制定个体化治疗方案。
      【关键词】 糖尿病；糖皮质激素；血糖；监测；波动
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2017）10—1569—04

Monitoring significance of 24 h blood glucose fluctuations in diabetic patients after the application ofglucocorticoid.
SHI Li 1, GU Jun 1, XU Zheng-rong 1, REN Wei-dong 1, ZHANG Zhi-ying 1, DONG Yun-cheng 1, YUANXiao-fei 2, YANG Jin-liang 3, CHEN Lei-gang 4, ZHANG Li-qian 1. Department of Endocrinology 1, Department ofHematology 2, Department of Immunology 3, Department of Dermatology 4, First Affiliated Hospital of Hebei North University,Zhangjiakou 075000, Hubei, CHINA
【Abstract】 Objective To observe the characteristics of 24 h blood glucose fluctuation in patients with type 2diabetes mellitus after undergoing different types of glucocorticoid therapy, so as to provide basis for early detection andfurther treatment of high blood glucose in patients with type 2 diabetes. Methods A total of 60 diabetic patients treatedwith glucocorticoid in Department of Dermatology, Endocrinology, Rheumatology and Hematology in First AffiliatedHospital of Hebei North University from March 2014 to March 2016 were divided into three groups, 20 cases in eachgroup, according to the different treatment methods. The patients in the DM1 group was given methylprednisolone 40 mg,dexamethasone 10 mg in DM2 group, and prednisone 30 mg in DM3 group. All the patients were continuously treatedfor 6 days. The 3 d continuous glucose monitoring were performed respectively in the three groups to detect the glucoseparameters，such as absolute means of daily difference (MODD), mean amplitude of glycemic excursions (MAGE), stan-dard deviation of blood glucose (SDBG) of one day, and mean postprandial glucose excursion (MPPGE). Glycosylatedhemoglobin (HbA1c) was detected on the second day of the 3 d continuous glucose monitoring. And blood sugar drift in-cluding hypoglycemia time ratio, high blood sugar ratio and blood sugar fluctuation coefficient in the patients amongthree groups were compared. Results The HbA1c, MAGE, SDBG, and MPPGE levels of the patients in DM2 groupwere higher than those in DM3 group and DM1 group, and HbA1c, MAGE, SDBG, MPPGE levels of patients in theDM3 group were higher than those in DM1 group, demonstrating statistically significant differences (P<0.01). No signif-icant difference in the MODD levels among the three groups was found (P>0.05). The time ratio of high blood sugar of·论 著·doi:10.3969/j.issn.1003-6350.2017.10.007基金项目：河北省卫计委课题（编号：20150465）