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目的 研究重症急性呼吸综合征 (SARS)治疗中应用超大剂量的糖皮质激素 (激素 )发生类固醇性糖尿病的频率及其危险因素。方法 收集在中日友好医院 3个病区住院的全部SARS患者 13 2例 ,记录甲泼尼龙应用剂量、疗程和糖尿病发生情况 ,分析了解类固醇性糖尿病发生的危险因素。结果 13 2例SARS患者中 95例 (71 9% )应用了糖皮质激素治疗 ,其中既往无糖尿病的 91例中3 3例在激素治疗期间发生了糖尿病。发生和未发生糖尿病两组间比较 ,患者日最大激素用量、日均激素用量、激素使用疗程均有显著差别 ,分别是 :2 75mg、13 9mg ;13 6mg、91mg ;16d、2 4d(P <0 0 1)。糖尿病发生率在最大剂量 >160mg/d患者组为最大剂量≤ 80mg/d组的 5倍 (64 7%比13 0 % ,P <0 0 5) ,疗程≥ 3周的患者组为疗程 <2周组的 3 6倍 (61 9%比 17 4% ,P <0 0 5)。每日平均剂量小于 90mg同时疗程短于 15d的患者糖尿病发生率仅为 10 5%。多因素分析在调整年龄、性别因素影响后 ,仅日最大激素用量与糖尿病发生显著相关。结论 SARS患者应用糖皮质激素治疗中糖尿病发生率很高。剂量过大和疗程过长都是重要危险因素 ,但过大的日剂量似乎更为重要
Objective To study the frequency and risk factors of steroid-induced diabetes mellitus (T2DM) using super-large doses of glucocorticoid (hormone) in the treatment of severe acute respiratory syndrome (SARS). Methods A total of 132 cases of SARS patients hospitalized in Sino-Japanese Friendship Hospital were collected. The dose, duration of treatment and diabetes mellitus of methylprednisolone were recorded, and the risk factors of steroid-induced diabetes mellitus were analyzed. Results Ninety-three (71.9%) of 132 SARS patients were treated with glucocorticoid, of whom 33 had diabetes without diabetes and 33 had diabetes during hormone therapy. There was a significant difference between the two groups in the occurrence and non-occurrence of diabetes. The daily maximum hormone dosage, daily hormone dosage, and hormonal treatment regimens were significantly different, which were 75 mg, 13 9 mg, 13 6 mg, 91 mg, 16 d, 24 d, 0 0 1). The incidence of diabetes in patients with a maximum dose of> 160 mg / d was 5 times the maximum dose of 80 mg / d (64 7% vs 130%, P 0 05) Weekly groups were 36 times (61 9% vs 174%, P <0 05). The average daily dose of less than 90mg at the same time course of treatment of patients shorter than 15d diabetes incidence was only 105%. Multivariate analysis After adjusting for age and sex, only the daily maximum hormonal dosage was significantly associated with diabetes. Conclusion The incidence of diabetes in SARS patients treated with glucocorticoids is very high. Overexposure and long course of treatment are both important risk factors, but excessive daily doses appear to be more important