【摘要】 目的 研究胰岛素低血糖激发试验(insulin tolerance test, ITT)按指南推荐剂量注射胰岛素后出现不充分低血糖的影响因素。方法 采用横断面研究设计，选取2010年01月至2021年12月于重庆医科大学附属第一医院内分泌科就诊的可疑成人生长激素(growth hormone, GH)缺乏患者，共416例(男性121例，女性295例),均行ITT。收集患者资料及生化信息，根据ITT过程中单次指南推荐剂量注射胰岛素(0.1～0.15 U/kg)后低血糖是否充分进行分组(充分低血糖组321人，不充分低血糖组95人)。采用多因素Logistic回归模型分析不充分低血糖的影响因素；采用受试者工作特征(receiver operating characteristic, ROC)曲线分析相关指标对不充分低血糖的预测价值，得出切点值。结果 充分低血糖组的年龄、体质指数(body mass index, BMI)、首次胰岛素剂量、基线血糖、基线GH、空腹胰岛素、糖化血红蛋白(glycosylated hemoglobin A1c, HbA1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterin, LDL-C)、甘油三酯(triglyceride, TG)均低于不充分低血糖组，高密度脂蛋白胆固醇(high density lipoprotein cholesterin, HDL-C)高于不充分低血糖组(P<0.05)。多因素Logistic回归分析结果显示，高BMI、高基线血糖、高LDL-C、低HDL-C是不充分低血糖的影响因素(P<0.05)。BMI预测不充分低血糖的ROC曲线下面积(area under the ROC curve, AUC)为0.880,约登指数计算此时BMI切点值为24.012,敏感度为0.832,特异度为0.804。BMI、基线血糖、LDL-C、HDL-C四者联合诊断预测不充分低血糖的AUC为0.909,敏感度为0.895,特异度为0.782。结论 高BMI、高基线血糖、高LDL-C、低HDL-C为不充分低血糖的影响因素，四者联合检测和BMI单一指标均对不充分低血糖有较高的预测价值。更多还原

【Abstract】 Objective To investigate the influencing factors of inadequate hypoglycemia after insulin injection at the guideline-recommended dose in the insulin tolerance test(ITT). Methods A cross-sectional study was conducted on 416 patients with suspected adult growth hormone(GH) deficiency(121 males and 295 females) in the outpatient department and inpatient department of endocrinology in the First Affiliated Hospital of Chongqing Medical University from January 2010 to December 2021. All patients completed the ITT. The clinical data and biochemical information of the patients were collected, according to whether hypoglycemia was sufficient after a single dose of insulin injection(0.1～0.15 U/kg) recommended by the guidelines during ITT. The patients were divided into the adequate group(n=321) and the inadequate group(n=95). Multivariate logistic regression model was used to analyze the influencing factors of inadequate hypoglycemia. The receiver operating characteristic(ROC) curve was used to analyze the predictive value of relevant indicators for inadequate hypoglycemia and to get the cut-off value. Results Age, BMI, initial insulin dose, baseline blood glucose, baseline GH, fasting insulin, glycated hemoglobin A1 c(HbA1 c), low density lipoprotein cholesterin(LDL-C) and triglyceride(TG) in the sufficient hypoglycemia group were lower than those in the inadequate hypoglycemia group, and high density lipoprotein cholesterin(HDL-C) was higher than that in the hypoglycemia group(P<0.05). Multivariate logistic regression model showed that high BMI, high baseline blood glucose, high LDL-C level and low HDL-C level were the influencing factors of inadequate hypoglycemia(P<0.05). The area under ROC curve(AUC) of BMI predicting hypoglycemia was 0.880, and the cut-off point of BMI calculated by Jorden index was 24.012, with a sensitivity of 0.832 and specificity of 0.804. The AUC of BMI, baseline blood glucose, LDL-C and HDL-C in the combined diagnosis of inadequate hypoglycemia was 0.909(sensitivity, 0.895; specificity, 0.782). Conclusion High BMI, high baseline blood glucose, high LDL-C level and low HDL-C level are the influencing factors of inadequate hypoglycemia. The combined detection of these 4 factors and BMI single index both have a high predictive value on inadequate hypoglycemia.更多还原