Glucose metabolism disorders in children with refractory nephrotic syndrome
Glucose metabolism disorders in children with refractory nephrotic syndrome
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DOI：
10.1007/s00467-019-04360-1
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发表时间：
2020-01-16
影响因子：
3
通讯作者：
Ariga, Tadashi
中科院分区：
文献类型：
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作者：
Takahashi, Toshiyuki;Okamoto, Takayuki;Ariga, Tadashi
背景难治性肾病综合征（NS）患者由于长期使用致糖尿病药物，特别是糖皮质激素和钙调神经磷酸酶抑制剂（CNI），因此面临药物引起的葡萄糖代谢紊乱的高风险。然而，目前尚未对难治性 NS 儿科患者的糖代谢紊乱进行全面评估。此外，在显示利妥昔单抗对难治性 NS 的有效性之前，不能在这些患者中停用糖皮质激素和 CNI，因此，在停用这些药物后评估葡萄糖代谢紊乱的机会有限。方法连续纳入开始接受利妥昔单抗治疗难治性 NS 的儿童患者。在利妥昔单抗治疗开始时，通过口服葡萄糖耐量试验 (OGTT) 和 HbA1c 水平评估他们的葡萄糖代谢状况。第一次评估时患有葡萄糖代谢紊乱的患者在大约 2 年后重新评估。结果 总体而言，57% (20/35) 的研究患者患有糖代谢紊乱，其中 40% (8/20) 的患者仅通过 2 小时 OGTT 血糖水平检测，而不通过空腹血糖或 HbA1c 水平检测。非肥胖/非超重患者的葡萄糖代谢紊乱明显多于肥胖/超重患者（p = 0.019）。此外，71%（10/14）的患者在停用糖皮质激素和CNI后仍存在糖代谢紊乱。结论 无论患者是否肥胖/超重，难治性 NS 患者发生糖代谢紊乱的风险很高，即使在儿童时期也是如此。非肥胖/非超重的糖尿病高危患者需要格外警惕。
Background Patients with refractory nephrotic syndrome (NS) are at high risk of medication-induced glucose metabolism disorders, because of their long-term use of diabetogenic medications, particularly glucocorticoids and calcineurin inhibitors (CNIs). However, there have been no comprehensive evaluations of glucose metabolism disorders in pediatric patients with refractory NS. Moreover, glucocorticoids and CNIs could not be discontinued in these patients until the effectiveness of rituximab on refractory NS was shown, and therefore, there has been limited opportunity to evaluate glucose metabolism disorders after discontinuation of these medications. Methods Consecutive pediatric patients who started rituximab treatment for refractory NS were enrolled. Their glucose metabolism conditions were evaluated using the oral glucose tolerance tests (OGTT) and HbA1c levels at the initiation of rituximab treatment. Patients with glucose metabolism disorders at the first evaluation were reevaluated after approximately 2 years. Results Overall, 57% (20/35) of study patients had glucose metabolism disorders, and 40% (8/20) of these patients were detected only by their 2-h OGTT blood glucose levels and not by their fasting blood glucose or HbA1c levels. Non-obese/non-overweight patients had significantly more glucose metabolism disorders than obese/overweight patients (p = 0.019). In addition, glucose metabolism disorders in 71% (10/14) of patients persisted after the discontinuation of glucocorticoids and CNIs. Conclusions Whether the patient is obese/overweight or not, patients with refractory NS are at high risk of developing glucose metabolism disorders, even in childhood. Non-obese/non-overweight patients who are at high risk of diabetes need extra vigilance.