转化医学杂志

目的 探究2型糖尿病（T2DM）合并慢性肾功能不全（CRI）患者血液透析（HD）过程中血糖波动情况及影响因素。方法 选取2021年1月至2024年6月于马鞍山市人民医院行HD治疗的98例T2DM合并CRI患者为研究对象，收集患者规律治疗3个月共24次血糖数据计算血糖标准差（SDBG）、平均波动幅度（MAGE）、最大波动幅度（LAGE）等血糖波动指标水平，分析HD过程中血糖波动情况；并据此参照相关指南分为血糖波动组及血糖稳定组，应用单因素和多因素Logistic回归分析其影响因素。结果 98例患者HD过程中SDBG为（2.58±1.16）mmol/L、MAGE为（4.92±1.47）mmol/L、LAGE为（6.21±2.98）mmol/L。有54例患者HD中出现血糖波动，发生率为55.10%(54/98)，据此分为血糖波动组（54例）及血糖稳定组（44例）。血糖波动组合并高血压史、合并焦虑/抑郁症、睡眠障碍、自我管理能力差患者占比、T2DM病程、透析当日胰岛素使用剂量、糖化血红蛋白、尿微量白蛋白（mALb）水平高于血糖稳定组，血钙（Ca）、甲状腺旁素（PTH）水平低于血糖稳定组（P<0.05）；多因素Logistic回归分析结果显示，高血压史、合并焦虑/抑郁症、自我管理能力、mALb水平是T2DM合并CRI患者HD过程中血糖波动的影响因素（P<0.05）。结论 在T2DM合并CRI患者HD过程中血糖波动发生率高，且受高血压史、合并焦虑/抑郁症、自我管理能力、m ALb水平影响较大。

Objective To explore blood glucose fluctuation and its influencing factors in patients with type 2 diabetes mellitus(T2DM) and chronic renal failure(CRF) during hemodialysis(HD). Methods A total of 98 patients with T2DM and CRF who underwent HD in Maanshan People's Hospital were enrolled as the research objects between January 2021 and June 2024. The blood glucose data(24 measurements) within 3 months of regular treatment were collected to calculate blood glucose fluctuation indexes [standard deviation of blood glucose(SDBG), mean amplitude of glycemic excursion(MAGE), large amplitude of glycemic excursion(LAGE)], and blood glucose fluctuation during HD was analyzed. According to the relevant guidelines, patients were divided into blood glucose fluctuation group and blood glucose stability group. The influencing factors of blood glucose fluctuation were analyzed by univariate and multivariate Logistic regression analysis. Results In the 98 patients during HD, SDBG, MAGE and LAGE were(2.58±1.16) mmol/L,(4.92±1.47) mmol/L and(6.21±2.98) mmol/L, respectively. There were 54 patients [55.10%(54/98)] with blood glucose fluctuation during HD. According to blood glucose status, patients were divided into blood glucose fluctuation group(n=54) and blood glucose stability group(n=44). Proportions of hypertension history, anxiety/depression, sleep disorders and poor self-management ability, course of DM, insulin dosage on dialysis day, glycosylated hemoglobin and microalbuminuria(mALb) in blood glucose fluctuation group were higher than those in blood glucose stability group, while level of calcium(Ca) and parathyroid hormone(PTH) were lower than those in blood glucose stability group(P<0.05). The results of multivariate logistic regression analysis showed that hypertension history, anxiety/depression, self-management ability and mALb were influencing factors of blood glucose fluctuation in patients with T2DM and CRF during HD(P<0.05). Conclusion The incidence of blood glucose fluctuation is high in patients with T2DM and CRF during HD. The influencing factors of blood glucose fluctuation include hypertension history, anxiety/depression, poor self-management ability and mALb level.