糖尿病合并血液透析患者血糖波动特征研究

Research on Glycemic Variability Characteristics in Diabetic Patients Undergoing Hemodialysis

摘要: 目的：应用持续葡萄糖监测(CGM)技术量化糖尿病合并维持性血液透析(MHD)患者在透析日与非透析日的血糖波动差异，解析血液透析对血糖稳定性的影响机制及临床管理启示。方法：前瞻性纳入25例糖尿病合并MHD患者(男19例，女6例)，采用微泰医疗(Microtech Medical) AiDEX®X持续葡萄糖监测系统连续监测14天血糖数据。对比透析日(HD日，n = 75次)与非透析日(非HD日，n = 100次)的血糖平均值(MBG)、最大值(Gmax)、最小值(Gmin)、标准差(SD)、极差(Range)、变异系数(CV)、目标范围内时间(TIR, 3.9~10.0 mmol/L)、高于范围时间(TAR, >10.0 mmol/L)及低于范围时间(TBR, <3.9 mmol/L)。结果：MBG (7.8 ± 1.1 vs 7.9 ± 1.3 mmol/L)、Gmax (15.2 ± 3.5 vs 14.8 ± 3.1 mmol/L)、TIR (68.3% ± 13.2% vs 66.7% ± 14.6%)、TAR (26.4% ± 12.1% vs 28.5% ± 13.9%)、TBR (5.3% ± 3.8% vs 4.8% ± 4.1%)组间无统计学差异(P > 0.05)；HD组的Gmin显著低于非HD组(3.1% ± 0.9 vs 3.8% ± 1.0 mmol/L, P < 0.01)，SD (3.1 ± 0.7 vs 2.4 ± 0.6 mmol/L)、Range (12.1 ± 3.2 vs 10.3 ± 2.9 mmol/L)、CV (39.7% ± 8.5% vs 30.4% ± 6.8%)显著增高(均P < 0.05)。结论：血液透析通过加剧急性血糖波动(血糖最低值降低23.7%、CV增幅30.6%)显著提升低血糖风险，但未延长低血糖持续时间。临床需构建以CV为核心的血糖波动管理体系，优化透析日个体化干预策略。

Abstract: Objective: To quantify the differences in glycemic variability between dialysis days and non-dialysis days in patients with diabetes undergoing maintenance hemodialysis (MHD) using continuous glucose monitoring (CGM) technology, and to analyze the impact mechanism of hemodialysis on glycemic stability and its implications for clinical management. Methods: A prospective study was conducted involving 25 patients with diabetes and MHD (19 males, 6 females). The Microtech Medical AiDEX®X CGM system was used to continuously monitor blood glucose for 14 days. Glycemic parameters on dialysis days (HD days, n = 75) were compared with those on non-dialysis days (non-HD days, n = 100), including mean blood glucose (MBG), maximum glucose (Gmax), minimum glucose (Gmin), standard deviation (SD), range, coefficient of variation (CV), time in range (TIR, 3.9~10.0 mmol/L), time above range (TAR, >10.0 mmol/L), and time below range (TBR, <3.9 mmol/L). Results: No statistically significant differences were found between the groups in MBG (7.8 ± 1.1 vs. 7.9 ± 1.3 mmol/L), Gmax (15.2 ± 3.5 vs. 14.8 ± 3.1 mmol/L), TIR (68.3% ± 13.2% vs. 66.7% ± 14.6%), TAR (26.4% ± 12.1% vs. 28.5% ± 13.9%), or TBR (5.3% ± 3.8% vs. 4.8% ± 4.1%) (P > 0.05). However, the HD group had a significantly lower Gmin compared to the non-HD group (3.1 ± 0.9 vs. 3.8 ± 1.0 mmol/L, P < 0.01), and significantly higher SD (3.1 ± 0.7 vs. 2.4 ± 0.6 mmol/L), Range (12.1 ± 3.2 vs. 10.3 ± 2.9 mmol/L), and CV (39.7% ± 8.5% vs. 30.4% ± 6.8%) (all P < 0.05). Conclusion: Hemodialysis significantly increases the risk of hypoglycemia by exacerbating acute glycemic fluctuations (as evidenced by a 23.7% decrease in the minimum glucose value and a 30.6% increase in CV), but does not prolong the duration of hypoglycemia. There is a clinical need to establish a CV-centered glycemic variability management system and to optimize personalized intervention strategies on dialysis days.