GLUCOSE-TOLERANCE IN PATIENTS WITH CYSTIC-FIBROSIS - 5-YEAR PROSPECTIVE-STUDY
GLUCOSE-TOLERANCE IN PATIENTS WITH CYSTIC-FIBROSIS - 5-YEAR PROSPECTIVE-STUDY
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DOI：
10.1136/bmj.311.7006.655
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发表时间：
1995-09-09
影响因子：
105.7
通讯作者：
KOCH, C
中科院分区：
文献类型：
--
作者：
LANNG, S;HANSEN, A;KOCH, C
目的-研究囊性纤维化患者糖尿病的患病率和发病率。设计-每年口服葡萄糖耐量试验的五年前瞻性研究。设置-CF中心哥本哈根，丹麦。受试者-191名2岁以上囊性纤维化患者。主要结果测量-葡萄糖耐量，空腹和葡萄糖负荷后的血浆葡萄糖浓度，结果：研究期间糖尿病患病率从11%（n=21）增加到24%（n=46），年发病率为4- 9%。糖尿病的诊断年龄中位数为21岁（范围3-40岁）。在诊断糖尿病时，33%的患者出现高血糖症状，16%的患者出现空腹高血糖（≥ 7.8 mmol/l），16%的患者出现血红蛋白A（1c）水平升高（>6.4%）。糖耐量受损意味着糖尿病的发生风险高于糖耐量正常者（优势比5.6）。然而，在58%的糖耐量受损患者中，在下一次年度测试时糖耐量正常。在所有五项测试中，只有37%的患者葡萄糖耐量正常。在这组患者中，空腹后和葡萄糖负荷后的中位血糖浓度和血红蛋白A（1c）水平增加了6- 8%during study. Conclusions囊性纤维化患者糖尿病的患病率和发病率高，并随年龄的增长而增加。由于高血糖症状、空腹高血糖和糖化血红蛋白水平升高不能可靠地识别糖尿病，我们建议所有10岁以上囊性纤维化患者每年进行口服葡萄糖耐量试验。
Objectives-To study prevalence and incidence of diabetes mellitus in patients with cystic fibrosis.Design-Five year prospective study with annual oral glucose tolerance tests.Setting-CF Center Copenhagen, Denmark.Subjects-191 patients with cystic fibrosis aged above 2 years.Main outcome measures-Glucose tolerance, plasma glucose concentrations after fasting and after glucose loading, and haemoglobin A(1c) levels.Results-Prevalence of diabetes increased from 11% (n=21) to 24% (n=46) during study, with annual age dependent incidence of 4-9%. Diabetes was diagnosed at median age of 21 (range 3-40). At diagnosis of diabetes, symptoms of hyperglycaemia were present in 33% of patients, fasting hyperglycaemia (greater than or equal to 7.8 mmol/l was seen in 16%, and increased haemoglobin A(1c) levels (>6.4%) were seen in 16%. Impaired glucose tolerance implied higher risk for development of diabetes than normal glucose tolerance (odds ratio 5.6). In 58% of cases with impaired glucose tolerance, however, glucose tolerance was normal at next annual test. Normal glucose tolerance was found in only 37% of patients at all five tests. Within this group of patients, median plasma glucose concentrations after fasting and after glucose loading and haemoglobin A(1c) levels increased by 6-8% during study.Conclusions-Prevalence and incidence of diabetes in cystic fibrosis patients was high and increased with age. Since hyperglycaemic symptoms, fasting hyperglycaemia, and increased levels of glycated haemoglobin did not reliably identify diabetes mellitus, we recommend annual oral glucose tolerance tests in all cystic fibrosis patients aged over 10 years.