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胰岛β细胞瘤患者72 h血糖谱分析

Characteristics of 72 h Glucose Profiles Detected by Continuous Glucose Monitoring System in Patients with Insulinoma

  • 摘要: 目的 分析胰岛β细胞瘤患者72 h血糖谱的特点,讨论持续动态血糖监测(CGM)在鉴别低血糖(尤其是胰岛β细胞瘤中)的应用价值。方法 连续纳入2009年10月至2011年11月在我院内分泌代谢科住院的胰岛β细胞瘤患者6例(A组,术后病理检查证实);另纳入71例糖耐量正常者(NGT)为对照组(B组)、3例反应性低血糖患者为C组。3组受试者均行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验,并应用持续动态血糖监测系统(CGMS)进行连续3 d的血糖监测。结合EasyGV分析CGM的平均血糖水平(MBG)、血糖标准差(SD)、低血糖指数(LBGI)、糖尿病血糖风险评估值 (GRADE)、M-值(M-value)、日间血糖平均绝对差(MODD)、平均血糖波动幅度(MAGE)及低血糖事件及时间分布。结果 ①A组患者糖化血红蛋白、空腹血糖及OGTT后2 h血糖较B组降低(P均<0.05)。②通过CGM发现,A组72 h MBG低于B组(P<0.001),A组GRADE值、LBGI、M-value、SD及MODD均较B组高(P均<0.05)。③A组患者佩戴CGMS期间,其中有5例患者发生低血糖事件(血糖<2.8 mmol/L)共27次,多在凌晨及早餐空腹,B组仅2例共发生了2次低血糖事件,C组1例发生2次低血糖事件。 结论 胰岛β细胞瘤日内血糖波动更大,低血糖发作频繁,以深夜、空腹及餐前低血糖居多。CGMS结合EasyGV关于低血糖风险方面的参数有助于诊断胰岛β细胞瘤。

     

    Abstract: Objective To identify the characteristics of glucose profiles in patients with insulinoma using continuous glucose monitoring system (CGMS). Methods Six patients with insulinoma (All of the patients were diagnosed after operations with pathological tests) admitted to the Department of Endocrinology and Metabolism, West China Hospital of Sichuan University from October 2009 to November 2011 were recruited for this study (group A). They were compared with 71 patients with normal glucose tolerance(NGT)(group B) and 3 patients with responsive hypoglycemia (group C). All of the participants received 75 g oral glucose tolerance tests (OGTT), insulin release tests, and 72 h CGM. Glucose fluctuations and hypoglycemia risks were assessed by the following parameters obtained from CGMS: mean blood glucose (MBG) and standard deviation (SD), mean amplitude of glycemic excursion (MAGE), mean daily differences (MODD), low glucose index (LBGI), glycaemic Risk Assessment Diabetes Equation (GRADE) and M-value. Results Group A had significantly lower levels of HbA1c, fasting blood glucose, and 2 h-BG than group B (P<0.05). Compared with Group B, Group A had lower levels of 72 h-MBG(P<0.001) and higher levels of LBGI, M-value, GRADE, SD and MODD (P<0.05). The insulinoma patients had 27 occasions of hypoglycemia (glucose<2.8 mmol/L), more likely in early morning, at a fasting state or preprandial periods. Such events were rare in the control groups (2 occasions in Group B and one occasion in Group C). Conclusion Insulinoma patients present a greater level of glucose fluctuations and frequent hypoglycemia. Hypoglycemia risk detected by CGM is helpful for differentiating diagnosis of insulinoma.

     

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