Glycemic control and FEV1 recovery during pulmonary exacerbations in pediatric cystic fibrosis-related diabetes.
Glycemic control and FEV1 recovery during pulmonary exacerbations in pediatric cystic fibrosis-related diabetes.
复制标题
DOI：
10.1016/j.jcf.2019.12.016
复制
发表时间：
2020-01
期刊：
影响因子：
--
通讯作者：
W. Okoniewski;K. Hughan;G. Weiner;D. Weiner;E. Forno
中科院分区：
文献类型：
--
作者：
W. Okoniewski;K. Hughan;G. Weiner;D. Weiner;E. Forno
囊性纤维化相关糖尿病(CFRD)的短期血糖控制是否与急性肺加重期间FEV1的恢复有关尚不清楚。方法分析2010-2016年间因肺加重而在本中心住院的所有6-21岁囊性纤维化相关糖尿病患者的数据，包括每次发作时的CFRD状态、每次发作期间记录的所有FEV1以及相关的临床变量。用血糖仪曲线下面积(AUC)指标分析血糖控制情况。结果在家中完成静脉抗生素治疗的CFRD患者的治疗时间比在医院接受完全治疗的患者长(22.2天比13.8天)。在完成家庭治疗的患者中，住院患者血糖控制较差与肺功能改善较低相关：比较每项血糖指数第75至第25个百分位数(即血糖控制“较差”与“较好”)，出院时FEV1恢复率血糖AUC低20.1%(95%CI−0.4%，−39.9%)；48 h AUC低20.9%(95%CI−2.7%，−39.1%)；AUC/d降低28.2%(95%CI−7.1%，−49.3%)。在静脉注射抗生素结束时和临床随访中也发现了类似的结果。同样，血糖控制差的患者住院期间FEV1恢复的斜率较低。对糖耐量正常的患者的分析基本上没有意义。未发现Hb A1c与FEV1恢复之间的相关性。结论在家庭完成静脉抗生素治疗的CFRD患者中，住院患者血糖控制不良与FEV1恢复较差相关，尽管治疗时间较长。
RationaleWhether short-term glucose control in cystic fibrosis-related diabetes (CFRD) is associated with FEV1recovery during acute pulmonary exacerbations is unclear.MethodsData from all patients with CFRD ages 6–21 years hospitalized in 2010–2016 for pulmonary exacerbations at our CF Center were analyzed, including CFRD status at each encounter, all FEV1recorded during each exacerbation, and relevant clinical covariates. Glucose control was analyzed using meter blood glucose area under the curve (AUC) indices. The primary outcome was FEV1recovery.ResultsPatients with CFRD who finished IV antibiotics at home were treated for longer than those fully treated in the hospital (22.2 vs. 13.8 days). In those who finished treatment at home, poor inpatient glycemic control was associated with lower lung function improvement: when comparing the 75th to the 25th percentile of each glycemic index (i.e., “poorer” vs. “better” glycemic control), FEV1recovery at discharge was 20.1% lower for glucose AUC (95%CI −0.4%, −39.9%); 20.9% lower for 48-h AUC (95%CI −2.7%, −39.1%); and 28.2% lower for AUC/day (95%CI −7.1%, −49.3%). Similar results were found at the end of IV antibiotics and at clinic follow-up. Likewise, patients with poor glycemic control had a lower slope of inpatient FEV1recovery. Analysis in patients with normal glucose tolerance was largely non-significant. No associations were found between hemoglobin A1c and FEV1recovery.ConclusionsIn patients with CFRD who complete IV antibiotic treatment at home, poor inpatient glycemic control is associated with worse FEV1recovery despite longer duration of treatment.