癌症合并糖尿病患者应用糖皮质激素安全性的前瞻性随机对照研究

目的从循证医学的角度探讨癌症合并糖尿病的患者使用糖皮质激素(glucorticoids,GC)是否安全。方法有糖尿病史或治疗前发现糖尿病者进入糖尿病组,无糖尿病史治疗前空腹血糖高于正常但未达到糖尿病诊断标准者进入空腹血糖损害(i m-paired fasting glucose,IFG)组,通过计算机随机筛选出最适合与实验组配对者作为对照组。GC及化疗根据需要按常规选择,定期测定全部患者的静脉血糖、糖尿病患者和IFG患者的毛细血管血糖,前瞻性评价GC治疗后的血糖变化、不良反应及其影响因素。结果糖尿病组患者29例,使用GC后恶心呕吐、腹部不适、头痛、失眠、肺炎、多汗、心慌及血压升高的比例高于对照组,但均无统计学意义。接受GC治疗期间,只有1例(3%)血糖正常,28例(97%)有1次以上血糖升高,显著高于对照组,t=6·309,P=0·000。但均在可以控制且不影响肿瘤治疗及GC治疗的范围内。对照组患者有5例(17%)血糖高于正常,其中1例血糖有4次血糖高于正常。入院前未接受降糖治疗的糖尿病患者,需要改变降糖措施的比例(2/11)高于入院前已接受降糖治疗的糖尿病患者(2/18)和IFG患者(2/24),但差异无统计学意义,F=0·73,P=0·694。IFG组24例,与糖尿病组有类似的结果。入院血糖正常的220例患者中,化疗后20例空腹血糖升高(9·09%)。未化疗仅使用GC者34例,4例空腹血糖升高(11·76%),无统计学意义。但在化疗患者中,不同的化疗方案影响血糖升高的发生率。NP方案治疗后发生空腹血糖升高的比例为34·61%,高于CAF(4·76%)、FLP(4·76%)、EP(3·70%)等治疗方案。结论癌症患者伴发糖尿病及IFG的比例远高于一般人群,但常规应用GC是安全的。血糖正常患者化疗同时使用GC,个别化疗药物、年龄、地塞米松日剂量和病期影响空腹血糖升高的发生率。

Study on safety of glucocorticoids to malignant tumors complicated with diabetes mellitus

OBJECTIVE:To evaluate the safety of normal dosage of glucocorticoids using in cancer patients with diabetes. METHODS:Twenty-nine cases of diabetic patients and 21 cases of impaired fasting glucose(IFG)were enrolled. The control groups were randomly selected from cancer patients with normal blood sugar through computer. Glucocorticoids and chemotherapy schemes were chosen in common practice. RESULTS: The incidences of nausea, vomitting, abdominal discomfort, headache, insomnia, pneumonia, hyperhidrosis, palpitation and hypertension in the patients with diabetes were slightly higher than took of control group after using glucocorticoids chemotherapy. Controllable hyperglycemia more than one time took place in 28 cases (97%) of diabetic group and which were significantly mose than that of the control( t= 6.309, P=0.000). The ratio of patients who had not takes hypoglycenic drug but needed to change hypoglycemic agent was 2/11, which was higher than that of patients who had taken (2/18), which was similar to IFG patients (2/24), (F=0.73, P=0.694). Among 220 patients with normal blood sugar, 20 cases of hyperglycemia occurred in 220 patients (9.09%) who received glucocorticoids combined with concurrent chemotherapy. Among 34 patients who received only GC, 4 cases occurred hyperglycemia (11.76%). The incidence of hyperglycemia was higher significantly in NP regimen (34.61%) than in CAF(4.76%), FLP(4.76%) and EP(3.70%). CONCLUSIONS: The morbidity of cancer patients with diabetes is higher significantly than that of general population. Howeres, it is safe to use glucocorticoids for the patients. The incidence of hyperglycemia may be also influenced by some cytotoxic drugs, age,dosage of dexamethasone and tumor stage.