儿童糖尿病酮症酸中毒及双胍类药物治疗中乳酸酸中毒问题的研究

目的：探讨１型糖尿病儿童酮症酸中毒时乳酸酸中毒发生情况，乳酸酸中毒与双胍类药物副作用的关系，双胍类药物在治疗１型糖尿病病人时的乳酸水平。方法：测定１９９６年２月－１９９７年１０月期间我院住院的１型糖尿病病人入院时乳酸水平，及纠正酸中毒后，双胍药治疗前后乳酸水平。结果：３３例病人入院时发生酮症酸中毒的有２３例，乳酸酸中毒１例。

Lactic Acidosis in IDDM Children Treated with Biguanides

Objective:In order to explore the lactic level and frequency of lactic acidosis (LA) as side effects of biguanide drugs. Methods:33 inpatients of IDDM children were treated with biguanides during Feb. 1996 to Oct. 1997.The dosage of phen-formin was 25 mg tid;or metformin 250 mg tid. Results:Only one case (3% ) had lactic acidosis (lactic level>5 mmol/L); 10 patients (30.3%) had hyperlacticemia (lactic level > 3 mmol/L); 21 patients (63.3%) had diabetes ketoacidosis (DKA). When DKA and LA were abolished with insulin therapy and liver and kidney functions were normal, biguanides had been given to them (phenformin for 29 cases; metformin for 4 cases). Before and after the treatment, the blood lactic levels showed no differences (t = 1.45,P>0.05). Rectilinear correlation analysis showed that there is negative correlation be-tween insulin dosage and time (r= - 0.980 5, P< 0.01) . Combination of biguanide agent and insulin therapy may decrease the dosage of insulin by 2/3 ~ 3/4. Conclusion: IDDM children treated with insulin and biguanide drugs, if dosage of bigua-nide was appropriate (phenformin 75 mg/d, metformin 750 mg/d) the blood lactic level would not be abnormal. Therefore biguanide agents could be a safe, effective treatment for IDDM,and reduced the sufferings caused by insulin injection and cost of medication.