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目的分析胰岛素瘤患者动态血糖监测系统(CGMS)血糖谱的特点,探讨CGMS在胰岛素瘤诊断中的价值。方法应用CGMS对6例经病理证实的胰岛素瘤患者(胰岛素瘤组)进行连续3 d的血糖监测,分析CGMS的平均血糖水平(MBG)、M-valueof Schlichtkrull(M-value)、血糖分布频率及低血糖事件,监测结果与5例新诊断2型糖尿病伴低血糖患者(糖尿病组)及6例正常糖调节者(对照组)进行比较。结果①胰岛素瘤组M-value显著高于对照组(P<0.01),而MBG两组间无显著性差异(P>0.05)。糖尿病组M-value及MBG均高于胰岛素瘤组及对照组(P<0.05或P<0.01)。②6例胰岛素瘤患者CGMS监测期间共发生36次低血糖事件,持续时间为3.6 h/d,其中21次(58.3%)发生于夜间;5例糖尿病患者共发生7次低血糖事件,持续时间为0.17 h/d,其中4次(57.1%)发生于夜间。③对照组99.2%的血糖波动于3.9～7.8 mmol/L;胰岛素瘤组血糖2.8～3.9mmol/L及≤2.8 mmol/L的分布频率均显著高于糖尿病组(P<0.01),而7.8～11.1 mmol/L及≥11.1 mmol/L的分布频率则低于糖尿病组(P<0.05和P<0.01)。结论CGMS可进一步分析低血糖的时间分布、类型及原因,结合M-value等血糖参数,有助于胰岛素瘤诊断水平的提高。
Objective To analyze the characteristics of glycometabolism in dynamic blood glucose monitoring system (CGMS) in patients with insulinoma and to explore the value of CGMS in the diagnosis of insulinoma. Methods 6 consecutive patients with insulinoma confirmed by histopathology (insulinoma group) were monitored by CGMS for 3 consecutive days. The mean blood glucose (MBG), M-value of Schlichtkrull (M-value) The hypoglycaemic event was compared with 5 newly diagnosed type 2 diabetic patients with hypoglycemia (diabetic group) and 6 normal glucose regulators (control group). Results ① The M-value in insulinoma group was significantly higher than that in control group (P <0.01), but there was no significant difference between two groups (P> 0.05). M-value and MBG in diabetic group were higher than those in insulinoma group and control group (P <0.05 or P <0.01). Six cases of insulinoma CGMS monitoring during the occurrence of a total of 36 hypoglycemic events, the duration of 3.6 h / d, of which 21 (58.3%) occurred in the night; five cases of diabetes patients with a total of seven hypoglycemic events for a duration of 0.17 h / d, of which 4 (57.1%) occurred at night. ③ The blood glucose of 99.2% in the control group fluctuated from 3.9 to 7.8 mmol / L. The distribution frequency of blood glucose of 2.8- 3.9 mmol / L and ≤2.8 mmol / L in insulinoma group was significantly higher than that in diabetic group (P <0.01) The frequencies of 11.1 mmol / L and 11.1 mmol / L were lower than those of diabetic group (P <0.05 and P <0.01). Conclusion CGMS can further analyze the time distribution, types and causes of hypoglycemia, and combine the blood sugar parameters such as M-value to help improve the diagnosis of insulinoma.