糖皮质激素治疗的SLE患者类固醇性高血糖的发生情况及相关因素分析

发布时间：2018-04-26 04:27

本文选题：类固醇性高血糖 + 糖皮质激素　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:回顾性分析GC治疗的SLE患者一般临床资料和类固醇性高血糖的发生情况,分析其发生的相关因素,为预防高血糖的发生及临床治疗提供参考依据。资料与方法:(1)收集2016年1月至2016年12月在吉林大学第一医院和吉林大学第二医院明确诊断为SLE的住院患者63例。(2)入组标准:明确诊断为SLE的患者,住院期间接受GC治疗;既往没有糖尿病病史,GC治疗前血糖正常;治疗期间有血糖、尿酸、血脂、C反应蛋白、血压等监测指标;出院后接受电话回访,有多次住院或门诊复查临床资料者。(3)排除标准:GC治疗前有糖耐量异常或糖尿病;诊断SLE前有服用GC史;诊断SLE后合并其他需GC治疗的疾病。(4)研究方法:收集患者的一般资料;实验室检查资料;自制问卷对患者进行电话回访,回访内容包括:GC应用时间、剂量,是否发生类固醇性高血糖;根据住院期间的血糖监测及院外的电话回访结果分为类固醇性高血糖组和血糖正常组。(5)统计学方法:采用SPSS 20.0软件进行分析,以p0.05为差异有统计学意义。结果:(1)63例SLE患者,类固醇性高血糖患者15例,占23.81%,其中糖尿病前期5例,占7.94%;类固醇性糖尿病(steroid-induced diabetes mellitus,SDM)10例,占15.87%。血糖正常者48例,占76.19%。15例类固醇性高血糖患者中,其中9例发生在GC治疗后12周内,4例发生在GC治疗后24周内,另外2例则在24周之后发生。SDM患者以餐后血糖升高为主,尤其是午餐后和晚餐后血糖。(2)两组比较,在发病年龄、体重指数、糖尿病家族史、GC起始剂量、GC冲击治疗方面、高甘油三酯血症方面差异有统计学意义(p0.05),即类固醇性高血糖组的发病年龄、体重指数、糖尿病家族史比例、GC起始剂量、GC冲击治疗比例、高甘油三酯血症比例高于血糖正常组;在性别、SLE疾病活动评分、狼疮肾炎、高血压病、GC治疗时间、使用免疫抑制剂、GC治疗前FBG水平、高胆固醇血症、高尿酸血症、C反应蛋白方面差异无统计学意义(p0.05)。(3)Logistic回归分析:发病年龄越大、体重指数越大、GC起始剂量越高是GC治疗的SLE患者发生类固醇性高血糖的危险因素。结论:(1)GC治疗的SLE患者,类固醇性高血糖的发病率高(为23.81%,其中糖尿病前期发病率7.94%;SDM发病率15.87%)。(2)GC治疗的SLE患者类固醇性高血糖发生时间较早,大部分在GC治疗后12周内。(3)GC治疗的SLE患者类固醇性糖尿病的血糖谱特点以餐后血糖升高为主,尤其是午餐后和晚餐后血糖。(4)发病年龄越大、体重指数越大、GC起始剂量越高的SLE患者,发生类固醇性高血糖的可能性越大。
[Abstract]:Objective: to retrospectively analyze the general clinical data and the occurrence of steroid hyperglycemia in patients with SLE treated with GC, and analyze the related factors to provide reference for the prevention of hyperglycemia and clinical treatment. Materials and methods from January 2016 to December 2016, 63 inpatients diagnosed as SLE in the first Hospital of Jilin University and the second Hospital of Jilin University were collected. There was no history of diabetes in the past. Blood glucose was normal before GC treatment. There were blood glucose, uric acid, blood lipids, C-reactive protein, blood pressure and so on. 3) exclusion criteria: abnormal glucose tolerance or diabetes before treatment; history of taking GC before diagnosis of SLE; diagnosis of SLE with other diseases requiring GC treatment. Methods: general data of patients were collected. The data of laboratory examination, self-made questionnaire, telephone interview, including the time of use of 1: GC, dosage, whether steroid hyperglycemia occurred or not; According to the results of blood glucose monitoring during hospitalization and telephone visits outside hospital, we divided them into steroid hyperglycemia group and normal blood glucose group. The statistical method was analyzed by SPSS 20.0 software, and the difference was statistically significant (p0.05). Results among 63 SLE patients, 15 were steroid hyperglycemia (23. 81%), 5 were prediabetic (7. 94), 10 were steroid-induced diabetes mellitus SDM (15. 87). There were 48 cases of normal blood glucose, accounting for 76.19% of the 15 cases of steroid hyperglycemia, of which 9 cases occurred within 12 weeks after GC treatment, 4 cases within 24 weeks after GC treatment, and the other 2 cases occurred postprandial hyperglycemia in 2 cases after 24 weeks. Especially after lunch and after dinner, the two groups were compared in age of onset, body mass index, family history of diabetes, GC initial dose and GC shock therapy. The difference in hypertriglyceridemia was statistically significant (p 0.05), that is, the age of onset, body mass index (BMI), family history of diabetes mellitus (DM), the initial dose of GC and the proportion of GC shock therapy were significantly higher in hypertriglyceridemia group than in normal glucose group, and the ratio of hypertriglyceridemia in hypertriglyceridemia group was higher than that in normal glucose group. The activity score of SLE, the time of GC treatment for lupus nephritis and hypertension, the level of FBG before treatment with immunosuppressant GC, hypercholesterolemia, There was no significant difference in C-reactive protein in hyperuricemia. Logistic regression analysis showed that the older the age of onset, the greater the body mass index and the higher the initial dose of GC were the risk factors of steroid hyperglycemia in SLE patients treated with GC. Conclusion the incidence of steroid hyperglycemia (23.81%) was higher in SLE patients treated with GC than that in control group (23.81%). The incidence of prediabetes was 7.94%. The incidence of steroid hyperglycemia in SLE patients treated with 15.87%).(2)GC was earlier than that in SLE patients. Most of the SLE patients who were treated with GC within 12 weeks were mainly characterized by postprandial hyperglycemia, especially after lunch and dinner. SLE patients with higher BMI and higher initial GC dose were more likely to develop steroid hyperglycemia.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.241

【相似文献】