118例库欣综合征患者糖代谢临床特点分析

Analysis of Clinical Characteristics of Glucose Metabolism in 118 Patients with Cushing’s Syndrome

摘要: 目的：分析库欣综合征患者的临床资料，了解库欣综合征患者糖代谢的特点。方法：回顾性分析2014-01-01至2019-05-31于青岛大学附属医院诊断为库欣综合征的118例患者的临床资料，以OGTT试验结果分为糖尿病组(DM组)、糖耐量减低组(IGT组)、糖耐量正常组(NGT组)，在DM组中根据平均血皮质醇水平(0点、8点、16点血皮质醇平均值)二分位法分为G1组(平均皮质醇水平大于725.3 nmol/L)、G2组(平均皮质醇水平小于725.3 nmol/L)。结果：库欣综合征合并糖尿病43例(36.4%)，糖耐量减低17例(14.4%)，糖耐量正常58例(49.2%)，DM组年龄、病程均高于NGT组(P < 0.05)，DM组病程高于IGT组(P < 0.05)。DM组和IGT组的血钙、白蛋白均较NGT组低(P < 0.05)，DM组HDL-C较NGT组低(P < 0.05)。G1组年龄、早餐后2 h、午餐后2 h、晚餐后2 h血糖平均值、血糖标准差、血糖变异系数均显著高于G2组(P < 0.05)，白蛋白、尿酸均低于G2组(P < 0.05)，空腹血糖、糖化血红蛋白两组间比较无明显差异(P > 0.05)。G1组较G2组餐后血糖升高更为明显。结论：库欣综合征患者糖代谢异常发生率高，年龄越大、病程越长的患者更容易发生糖代谢异常；皮质醇水平相对更高的糖尿病患者餐后血糖升高更明显，血糖波动更大，应注重餐后血糖的管理，降低血糖波动。

Abstract: Objective: To analyze the clinical data of Cushing’s syndrome patients and understand the characteristics of glucose metabolism in Cushing’s syndrome patients. Methods: The clinical data of 118 patients with Cushing’s syndrome diagnosed in Qingdao University Affiliated Hospital from January 2014 to May 31, 2019 were analyzed retrospectively. According to OGTT test results, they were divided into the diabetes group (DM group), the impaired glucose tolerance group (IGT group) and the normal glucose tolerance group (NGT group)., According to the average cortisol level (0, 8, 16 point blood cortisol average) dichotomy, DM group was divided into G1 group (average cortisol level greater than 725.3 nmol/L), and G2 group (average cortisol level less than 725.3 nmol/L). Results: Cushing’s syndrome was complicated with diabetes in 43 cases (36.4%), impaired glucose tolerance in 17 cases (14.4%) and normal glucose tolerance in 58 cases (49.2%). The age and course of disease in DM group were higher than those in NGT group (P < 0.05), and the course of disease in DM group was higher than that in IGT group (P < 0.05). Serum calcium and albumin in DM group and IGT group were lower than those in NGT group (P < 0.05), and HDL-C in DM group was lower than that in NGT group (P < 0.05). Age, blood glucose average, blood glucose standard deviation, and blood glucose coefficient of variation 2 hours after breakfast, 2 hours after lunch, 2 hours after dinner of G1 group were significantly higher than those of G2 group (P < 0.05); albumin and uric acid were lower than G2 group (P < 0.05). There was no significant difference between the two groups in fasting blood glucose and glycosylated hemoglobin (P > 0.05). Compared with G2 group, the postprandial blood glucose in G1 group increased more obviously. Conclusion: Patients with Cushing’s syndrome have a high incidence of abnormal glucose metabolism. Patients with older age and longer course of the disease are more likely to develop abnormal glucose metabolism. Diabetes patients with relatively higher levels of cortisol have more significant postprandial blood glucose rises and greater blood glucose fluctuations. We should pay attention to the management of postprandial blood glucose and reduce the blood glucose fluctuation.