糖尿病血液透析患者透析过程中低血糖发生情况及其影响因素研究

背景　糖尿病血液透析（HD）患者透析过程中易发生低血糖，尤其是无症状性低血糖，但目前关于糖尿病HD患者透析过程中发生低血糖影响因素的研究报道较少。目的　分析糖尿病HD患者透析过程中低血糖发生情况及其影响因素。方法　选取2017年1月-2019年12月在杭州市西溪医院血透中心行HD的糖尿病患者86例，均接受常规治疗、血糖控制治疗。监测所有患者在研究开始后1个月12次HD过程中（上机30 min内）血糖值，分析其低血糖发生情况及血糖变异性；糖尿病HD患者透析过程中发生低血糖的影响因素分析采用单因素分析和多元有序Logistic回归分析。结果　86例患者中40例未发生低血糖（未发组），24例发生1次低血糖（偶发组），22例发生≥2次低血糖（常发组），低血糖发生率为53.5%（46/86）。三组患者年龄、体质指数（BMI）、子女情况、文化程度、用药依从性、照顾能力、血糖平均值（MBG）、血糖变异系数（CVBG）比较，差异有统计学意义（P<0.05）；多元有序Logistic回归分析结果显示，年龄增大〔OR=1.079，95%CI（1.000，1.160）〕、用药依从性差〔OR=13.250，95%CI（2.300，76.250）〕、照顾能力差〔OR=4.067，95%CI（1.090，15.300）〕、MBG<8.91 mmol/L〔OR=4.001，95%CI（1.250，12.850）〕是糖尿病HD患者透析过程中发生低血糖的危险因素，而BMI增大〔OR=0.776，95%CI（0.640，0.950）〕、CVBG<0.26〔OR=0.254，95%CI（0.080，0.790）〕是保护因素（P<0.05）。结论　糖尿病HD患者透析过程中低血糖发生率较高（为53.5%），年龄增大、用药依从性差、照顾能力差、MBG<8.91 mmol/L是糖尿病HD患者透析过程中发生低血糖的危险因素，而BMI增大、CVBG<0.26是保护因素。

Prevalence and Influential Factors of Hemodialysis-induced Hypoglycemia in Diabetes Mellitus Patients Undergoing Hemodialysis

Background　Diabetes mellitus patients are prone to hypoglycemia during hemodialysis，especially asymptomatic hypoglycemia.However，there are few studies about the influential factors of hemodialysis-induced hypoglycemia in diabetes mellitus patients undergoing hemodialysis.Objective　To explore the prevalence and influential factors of hemodialysis-induced hypoglycemia in diabetes mellitus patients undergoing hemodialysis.Methods　A total of 86 diabetes mellitus patients undergoing hemodialysis from January 2017 to December 2019 were selected from Dialysis Center，Xixi Hospital of Hangzhou.All of them received conventional treatment and glycemic control therapy.Blood glucose during 12 times of hemodialysis（within 30 minutes after using the hemodialysis machine）in the first month following the initiation of the study were monitored，and hypoglycemia events as well as glucose variability were analyzed.Univariate analysis and multiple ordinal Logistic regression analysis were performed to identify the influential factors of hemodialysis-induced hypoglycemia in diabetes mellitus patients undergoing hemodialysis.Results　Of the 86 patients，40 had no hypoglycemia，24 had one hypoglycemia，and other 22 had at least two hypoglycemia，with an overall hypoglycemia prevalence of 53.5%（46/86）.The three groups showed significant differences in mean age，BMI，and number of children，distribution of educational level，medication compliance，and self-care ability，as well as mean blood glucose and mean coefficient of variability of blood glucose（P<0.05）.Multiple ordinal Logistic regression analysis results demonstrated that，older age〔OR=1.079，95%CI（1.000，1.160）〕，poor medication compliance〔OR=13.250，95%CI（2.300，76.250）〕，poor self-care ability〔OR=4.067，95%CI（1.090，15.300）〕and mean blood glucose less than 8.91 mmol/L〔OR=4.001，95%CI（1.250，12.850）〕were associated with higher risk of hemodialysis-induced hypoglycemia in diabetes mellitus patients undergoing hemodialysis，while elevated BMI〔OR=0.776，95%CI（0.640，0.950）〕and mean coefficient of variability of blood glucose less than 0.26〔OR=0.254，95%CI（0.080，0.790）〕were associated with decreased risk of hemodialysis-induced hypoglycemia（P<0.05）.Conclusion　The prevalence of hemodialysis-induced hypoglycemia is relativity high（which is 53.5%）in diabetes mellitus patients undergoing hemodialysis，whose risk may be increased with older age，poor medication compliance，poor self-care ability and mean blood glucose less than 8.91 mmol/L，and may be reduced with elevated BMI and mean coefficient of variability of blood glucose less than 0.26.