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目的分析2型糖尿病合并肺癌患者血糖波动对化疗的影响。方法 80例2型糖尿病合并肺癌患者,根据日内平均血糖波动幅度(mean amplitude of plasma glucose excursion,MAGE)是否高于3.9mmol/L将患者分为正常波动组42例和高波动组38例。观察并比较2组肿瘤标志物、炎症因子水平及不良反应发生情况。结果高波动组MAGE[(5.75±1.28)mmol/L]、日间血糖平均绝对差[(1.45±0.64)mmol/L]、变异系数(1.68±0.73)、最大血糖波动幅度[(6.58±2.34)mmol/L]、空腹血糖[(7.26±1.52)mmol/L]和餐后2h血糖水平[(9.89±2.63)mmol/L]高于正常波动组[(3.79±1.03)mmol/L、(1.13±0.38)mmol/L、1.25±0.79、(4.11±1.52)mmol/L、(6.28±1.07)mmol/L、(7.68±1.65)mmol/L],差异均有统计学意义(P<0.05),高波动组患者癌胚抗原[(16.15±1.34)mg/L]、神经元特异性烯醇化酶[(18.92±4.32)mg/L]、细胞角蛋白19片段[(7.34±2.28)mg/L]、糖类抗原19-9[(77.26±6.67)u/mL]、糖类抗原153[(51.18±5.73)u/mL]、糖类抗原125[(85.19±7.16)u/mL]和鳞状上皮细胞癌抗原[(4.57±1.39)μg/L]、白细胞介素-6[(28.79±6.23)mg/L]、高敏C-反应蛋白[(23.46±3.42)mg/L]、肿瘤坏死因子-α[(56.57±7.56)ng/L]水平高于正常波动组[(12.62±2.32)mg/L、(16.39±3.63)mg/L、(5.27±1.47)mg/L、(55.41±5.21)u/mL、(43.25±5.54)u/mL、(62.23±6.43)u/mL、(2.46±0.75)μg/L、(17.22±3.51)mg/L、(11.64±3.25)mg/L、(39.75±5.64)ng/L](P<0.05),高波动组静脉炎(31.58%),消化道反应(31.58%),口腔溃疡(26.32%),肝、肾功能损害(44.74%)等化疗不良反应发生率高于正常波动组(7.14%、11.90%、4.76%、14.29%)(P<0.05)。结论 2型糖尿病合并肺癌患者高幅度的血糖波动不利于肿瘤标志物水平和炎症细胞因子水平的控制,且可增加化疗不良反应发生率。
Objective To analyze the effect of blood glucose fluctuation on the chemotherapy in type 2 diabetic patients with lung cancer. Methods Eighty patients with type 2 diabetes mellitus (T2DM) with lung cancer were divided into two groups according to whether the average amplitude of plasma glucose excursion (MAGE) was higher than 3.9mmol / L in 42 patients with normal fluctuation and 38 patients with high fluctuation. Observed and compared two groups of tumor markers, levels of inflammatory cytokines and adverse reactions. Results The mean absolute difference of daytime blood glucose [(1.45 ± 0.64) mmol / L], the coefficient of variation (1.68 ± 0.73) and the maximal fluctuation of blood glucose [(5.75 ± 1.28) mmol / ), fasting blood glucose (7.26 ± 1.52) mmol / L, and postprandial blood glucose 2h (9.89 ± 2.63 mmol / L) were significantly higher than those in the normal fluctuation group (3.79 ± 1.03 mmol / L, 1.13 ± 0.38 mmol / L, 1.25 ± 0.79, 4.11 ± 1.52 mmol / L, 6.28 ± 1.07 mmol / L, 7.68 ± 1.65 mmol / L respectively], the difference was statistically significant (P <0.05 (16.15 ± 1.34) mg / L], neuron specific enolase [(18.92 ± 4.32) mg / L] and cytokeratin 19 [(7.34 ± 2.28) mg / L], carbohydrate antigen 19-9 [(77.26 ± 6.67) u / mL], carbohydrate antigen 153 [(51.18 ± 5.73) u / mL] (4.57 ± 1.39 μg / L), IL-6 [(28.79 ± 6.23) mg / L] and high-sensitivity C-reactive protein [(23.46 ± 3.42) mg / L] The level of tumor necrosis factor-α [(56.57 ± 7.56) ng / L] was significantly higher than that of the normal fluctuation group [(12.62 ± 2.32) mg / L, (16.39 ± 3.63) mg / 55.41 ± 5.21) u / mL, (43.25 ± 5.54) u / mL, (62.23 ± 6.43) u / mL, (2.4 (P <0.05). The rate of phlebitis (31.58%) in the high-fluctuation group was significantly higher than that in the high-fluctuation group (6 ± 0.75 μg / L, 17.22 ± 3.51 mg / L, 11.64 ± 3.25 mg / L, (31.58%), oral ulcer (26.32%) and liver and renal dysfunction (44.74%) were higher than those in the normal fluctuation group (7.14%, 11.90%, 4.76%, 14.29% P <0.05). Conclusions The high blood sugar fluctuation in patients with type 2 diabetes mellitus complicated with lung cancer is not conducive to the control of tumor marker levels and inflammatory cytokines, and may increase the incidence of adverse reactions of chemotherapy.