【摘要】 目的 探讨糖尿病肾病患者在不同发展阶段血糖、胰岛素用量等变化情况。方法回顾分析广州市第一人民医院2009年1月~2014年12月收治的糖尿病肾病患者63例的临床资料,按美国肾病基金会K/DOQI指南对慢性肾脏病(CKD)分组建议及与血液透析关系分为5期,分别观察并记录患者CKD1~2期(Ⅰ期)、CDK3~4期(Ⅱ期)、CKD5期透析前(Ⅲ期)、透析1~3个月(Ⅳ期)、透析大于6个月(Ⅴ期)5期的胰岛素用量,检测患者血糖、血清白蛋白、血红蛋白变化情况,记录低血糖事件发生情况。结果患者Ⅰ期胰岛素用量[(0.63±0.21)U/kg]明显高于Ⅱ期和Ⅲ期胰岛素用量[(0.43±0.18)、(0.41±0.19)U/kg],差异有统计学意义(P<0.05);Ⅲ期胰岛素用量明显高于Ⅳ期胰岛素用量和Ⅴ期胰岛素用量[(0.32±0.19)、(0.28±0.21)U/kg],差异有统计学意义(P<0.05);Ⅳ、Ⅴ期低血糖事件发生率显著高于Ⅲ期,差异有统计学意义(P<0.05)。结论糖尿病肾病患者从CKD1~2期发展至CKD3~4期胰岛素用量需要减量,从CKD3~4期发展至CKD5期未予透析治疗前胰岛素用量未见明显下降,但经过短期(1~3个月)透析后胰岛素用量需要继续减量,患者进入长期透析(透析大于6个月)后胰岛素用量无明显变化,但透析患者低血糖发生率增加。更多还原

【Abstract】 Objective To discuss the changes of blood glucose, insulin dosage of patients with diabetic nephropathy at the different stage of the disease. Methods From January 2009 to December 2014, in Guangzhou First People’s Hospital, the clinical data of 63 patients with diabetic nephropathy were retrospectively analyzed, 5 periods were divided according to CKD and the relationship of hematodialysis, the insulin dosage of patients at CKD1-2 period(period Ⅰ),CDK3-4 period(period Ⅱ), CKD5 period before hemodialysis(period Ⅲ), hemodialysis 1-3 months(period Ⅳ),hemodialysis > 6 month(period Ⅴ), blood glucose, serum albumin, hemoglobin, hypoglycemia of patients were recorded. Results The insulin dosage of patients at periodⅠ[(0.63±0.21) U/kg] was higher than those at period Ⅱ and period Ⅲ [(0.43±0.18),(0.41±0.19) U/kg], the differences were statistically significant(P < 0.05); this at period Ⅲ was higher than those at period Ⅳ and period Ⅴ [(0.32±0.19),(0.28±0.21) U/kg], the differences were statistically significant(P < 0.05); the occurrence rates of hypoglycemia at period Ⅳ and period Ⅴ were higher than that at period Ⅲ,the differences were statistically significant(P < 0.05). Conclusion From CKD1-2 period to CKD3-4 period, insulin dosage of patients with diabetic nephropathy need to reduce, from CKD3-4 period to CKD5 period before dialysis, insulin dosage has no significant decrease, but after hemodialysis for a short time(1-3 months), insulin dosage need to further reduce, after long-term hemodialysis(more than 6 months), insulin dosage has no significant decrease, but the occurrence rate of hypoglycemia increases.更多还原