淋巴瘤化疗继发糖尿病临床分析

发布时间：2018-11-19 08:23

【摘要】：目的分析淋巴瘤患者在化疗过程中出现继发糖尿病的发生率及相关因素,探索化疗后出现继发糖尿病的危险因素。方法收集我院从2011年1月至2015年12月期间收治的住院接受化疗的淋巴瘤患者,共计207例,其中21例患者化疗前有糖尿病病史或糖尿病家族史,最终将符合条件的且临床资料完整的186例淋巴瘤患者的纳入本次研究。186例患者均无糖尿病家族史,化疗前也无糖尿病病史及血糖升高情况。其中,男性患者共92例(49.5%),女性患者共94例(50.5%);40岁及以上的患者共135例(72.5%),40岁以下的患者共51例(27.5%)。根据糖尿病的诊断标准,对化疗后患者血糖情况进行统计,分析淋巴瘤患者化疗后出现继发糖尿病的发生率。并根据血糖情况将其分为2组:化疗后继发糖尿病组和血糖正常组。比较分析两组患者的一般特征,分别对两组患者的年龄、性别、病理分型、临床分期、B症状、4~6疗程化疗后评估是否完全反应(CR,complete response)等进行logistic回归分析。首先,通过单因素logistic回归分析,筛选出化疗继发糖尿病的可能相关因素。然后,在对这些可能的相关因素进行多因素logistic回归分析,探索化疗后出现继发糖尿病的危险因素。结果186例淋巴瘤患者中,有48例(25.8%)患者化疗后出现继发糖尿病。化疗继发糖尿病的发生率为25.8%。单因素分析显示:年龄≥40岁、有B症状、首次未完全反应是化疗继发糖尿病的相关危险因素。而未得出性别、临床分期、病理类型与化疗继发糖尿病相关,因此不是继发糖尿病的危险因素。通过单因素分析得出的相关危险因素:年龄、B症状、首次未完全反应再进行logistic多因素回归分析,结果显示:40岁以上淋巴瘤患者化疗后发生继发糖尿病的风险是40岁以下患者出现继发糖尿病的风险的9.2倍(OR=9.200),有B症状的患者发生继发糖尿病的风险是无B症状患者的2.9倍(OR=2.903),4~6疗程化疗后评估,首次未完全反应患者发生继发糖尿病的风险是首次完全反应的2.08倍(OR=2.080)。结论继发糖尿病是淋巴瘤患者化疗期间的重要并发症,发生率为25.8%。其中,年龄≥40、B症状、首次未完全反应为化疗继发糖尿病的独立危险因素。继发糖尿病作为化疗的重要并发症之一,已引起越来越多临床医生的重视。化疗继发糖尿病影响患者的生存和预后,因此,在化疗过程中应加强化疗后患者血糖水平的监测和糖尿病症状的关注,尤其是对于年龄≥40岁、出现B症状、化疗后评估,首次未完全反应的淋巴瘤患者。对于出现糖尿病症状及血糖水平异常的患者,及时采取有效措施控制血糖水平,以降低患者在化疗过程中出现血糖升高的发生几率,保证化疗顺利进行,减少糖尿病并发症的发生,提高患者生活质量,延长生存期。
[Abstract]:Objective to analyze the incidence and related factors of secondary diabetes mellitus in lymphoma patients during chemotherapy, and to explore the risk factors of secondary diabetes mellitus after chemotherapy. Methods A total of 207 patients with chemotherapeutic lymphoma were collected from January 2011 to December 2015 in our hospital. Among them, 21 patients had a history of diabetes or a family history of diabetes before chemotherapy. 186 cases of lymphoma patients with complete clinical data were included in this study. 186 patients had no family history of diabetes, no history of diabetes and elevated blood glucose before chemotherapy. Among them, 92 cases (49.5%) were male, 94 cases (50.5%) were female, 135 cases (72.5%) were over 40 years old, 51 cases (27.5%) were under 40 years old. According to the diagnostic criteria of diabetes, the incidence of secondary diabetes in lymphoma patients after chemotherapy was analyzed. The patients were divided into two groups according to their blood glucose status: secondary diabetes after chemotherapy and normal blood glucose. The general characteristics of the two groups were compared and analyzed. The age, sex, pathological type, clinical stage, B symptom and CR,complete response after 4 courses of chemotherapy were analyzed by logistic regression analysis. First, univariate logistic regression analysis was used to screen the possible risk factors for diabetes secondary to chemotherapy. Then, multivariate logistic regression analysis was carried out to explore the risk factors of secondary diabetes after chemotherapy. Results among 186 cases of lymphoma, 48 cases (25.8%) developed secondary diabetes after chemotherapy. The incidence of diabetes secondary to chemotherapy was 25. 8%. Univariate analysis showed that age 鈮，

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