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目的:评估终末期糖尿病肾病患者的糖代谢特点及腹膜透析(PD)对糖代谢的影响。方法:选取我院终末期糖尿病肾病患者19例,使用动态血糖监测系统分别监测患者PD前后24 h血糖,计算日间与夜间平均血糖、标准差、最高血糖、最低血糖、平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、高血糖及低血糖的构成比,测定每组患者的糖化血红蛋白(HbA1c)、空腹及餐后2 h C肽水平,并根据HbA1c估算平均血糖。结果:PD后患者的外源性胰岛素用量、空腹及餐后2 h C肽水平均较PD前显著增高;PD前后按HbA1c估算的平均血糖值与实际测得的血糖值存在显著差异;PD前低血糖及高血糖比例、日间及夜间MAGE及LAGE均高于PD后。结论:PD后患者的胰岛素使用量虽显著增加,但PD可改善终末期糖尿病肾病患者的血糖波动。HbA1c不能准确反映终末期糖尿病肾病患者的平均血糖水平。
Objective: To assess the characteristics of glucose metabolism in patients with end stage diabetic nephropathy and the effects of peritoneal dialysis (PD) on glucose metabolism. Methods: Twenty-nine patients with end-stage diabetic nephropathy were enrolled in this study. The levels of blood glucose, standard deviation, maximum blood glucose, minimum blood glucose and mean blood glucose fluctuation (MAGE ), Maximal amplitude of blood glucose (LAGE), hyperglycemia and hypoglycemia, HbA1c, fasting and postprandial 2-h C-peptide levels in each group were measured. Mean blood glucose was estimated based on HbA1c. Results: Exogenous insulin, fasting and postprandial 2-h C-peptide levels in patients with PD were significantly higher than those before PD. There was a significant difference between the mean blood glucose estimated by HbA1c before and after PD and the actual blood glucose level. Before PD Hypoglycaemic and hyperglycemic ratios were higher in MAGE and LAGE during daytime and at night than after PD. CONCLUSIONS: Despite a significant increase in insulin use after PD, PD may improve glycemic fluctuations in patients with end stage diabetic nephropathy. HbA1c does not accurately reflect the average glucose level in patients with end stage diabetic nephropathy.