应用碘造影剂前后停用二甲双胍对糖尿病患者血糖水平的影响

目的探讨使用碘造影剂前后停用二甲双胍对糖尿病患者血糖水平的影响。方法研究对象选自2012年1月1日至12月31日在北京大学第一医院住院的糖尿病患者，入选标准为使用含二甲双胍方案治疗后血糖水平基本达标并维持平稳、应用碘造影剂前后48h内停用二甲双胍且有停药前后空腹、早餐后2h、午餐后2h、晚餐后2h和睡前血糖水平监测记录。停用二甲双胍期间调整降糖治疗方案者纳入调整组，未调整治疗方案者纳入未调整组。收集2组患者的病历资料进行回顾性分析。结果共收集到符合入选标准的患者80例，其中未调整组62例（87．5％），调整组18例（22．5％）。二甲双胍停药时间为2—4d。未调整组停药后空腹、早餐后2h、午餐后2h、晚餐后2h和睡前血糖水平与停药前比较，均有不同程度的升高[（7．7±1．4）mmol／L比（7．0±1．2）mmol／L，（9．5±1．7）rnmol／L比（9．0±1．8）mmol／L，（10．9±2．3）mmol／L比（8．6±1．9）mmol,／L，（9．9±1．7）mmol／L比（8．6±1．7）mmol／L，（9．1±1．9）mmol／L比（8．5±1．6）mmo]／L]，其中空腹、午餐后2h和晚餐后2h血糖水平与停药前比较差异有统计学意义（P=0．01，P=0．00，P=0．00）；调整组停用二甲双胍前后5个时间点血糖水平差异均无统计学意义[（7．9±1．2）mmol．／L比（8．1±1．8）mmol／L，（8．0±2．2）mmol／L比（8．5±2．4）mmo]／L，（9．2±2．9）mmol／L比（10．3±1．9）mmoL／L，（9．4±2．1）mmol／L比（9．1±2．4）mmol／L，（10．0±2．3）mmol／L比（9．3±2．2）mmol／L，均P〉0．05]。结论使用碘造影剂前后停用二甲双胍可导致停药期间未调整降糖治疗方案的糖尿病患者血糖水平出现有统计学意义的升高，调整降糖治疗方案有利于患者血糖水平控制更平稳。

Effects of metformin discontinuation before and after iodine contrast agents use on blood glucose levels in diabetic patients

Objective To explore the effects of metformin discontinuation before and after iodine contrast agents use on blood glucose levels in diabetic patients. Methods All subjects were diabetic inpatients in Peking University First Hospital from January 1 to December 31, 2012. The inclusion criteria included that the blood glucose levels were basically within safe range, metformin was stopped 48 hours before and after iodine contrast agents use, and the glucose levels were monitored and recorded at five time points （fasting, 2 h after breakfast, 2 h after lunch , 2 h after supper and before bedtime ）. The patients whose hypoglycemic therapies were adjusted during metformin discontinuation were entered in the adjustment group and the patients whose hypoglycemie therapies were not adjusted during metformin discontinuation were entered in the non-adjustment group. The clinical data of patients in the 2 groups were collected and retrospectively analyzed. Results A total of 80 patients in accordance with inclusion criteria were enrolled in this study. Of them, 62 patients （87.5%） were in the non-adjustment group and 18 （22.5%） were in the adjustment group. The metformin was stopped 2-4 days. The blood glucose levels in the patients in the non-adjustment group increased to different degrees at five-point [ （7.7 ± 1.4 ） mmol/L vs. （7.0 ± 1.2 ） mmol/L, （9.5 ± 1.7） mmol/L vs. （9.0± 1.8） mmol/L, （ 10.9 ±2.3） mmoL/L vs. （8.6 ± 1.9） mmol/L, （9. 9 ± 1.7） mmol/L vs. （ 8.6 ± 1.7 ） retool/L, （ 9.1 ± 1.9 ） mmol/L vs. （ 8.5 ± 1.6 ） mmol/L l after drug discontinuation. Compared with before drug discontinuation, the blood glucose levels at fasting, 2 h after lunch and 2 h after super increased signifieantly （P = 0.01, P = 0.00, P = 0.00 ）. The differences of theblood glucose levels before and after drug discontinuation in the patients in the adjustment group were not statistically significant [ （7.9 ±1.2） mmol/L vs. （ 8. 1 ± 1.8 ） retool/L, （ 8.0 ± 2.2 ） mmol/L vs. （ 8.5 ±2. 4） retool/L, （9.2±2. 9） mmol/L vs. （10.3 ± 1.9）mmol/L, （9.4 ±2.1） mmol/L vs. （9.1 ±2.4） mmol/L, （10.0±2.3）mmol/L vs. （9.3 ±2.2）retool/L; P〉0.05 for all comparisons. Conclusions The blood glucose levels increased significantly in diabetic patients without adjusting hypoglycemic therapy when metformin was stopped before and after iodine contrast agents use. The adjustment for hypoglycemic therapy will benefit the control of blood glucose level.