再谈口服降糖药的安全性.ppt

* 這項研究要确定慢性肾病CKD病患发生低血糖的发生率，不论其是否患糖尿病，以及低血糖与死亡率之间的关系。研究分析了243,222位病患，這些病患在退伍軍人健康事務署中接受後續追蹤，期間總共有2,040,206次血糖測量記錄，在測量血糖後一天分析死亡率。慢性肾病（CKD）是低血糖的危险因子。与低血糖有关的死亡率使得它成為CKD病患病患安全的一個重大威胁。　 相較於沒有患CKD病患（估計肾小球清除率<60 ml/分钟/1.73 m2），那些有CKD的患者，低血糖的发生率较高，低血糖的定义为血糖值低于70 mg/dl。CKD相較於非CKD患者，低血糖发生率分別为每月每100位病患10.72位与5.33位，而沒有糖尿病的患者，分別是每月每100位病患3.46与2.23位。不论何种程度的低血糖，一天后的死亡率都显著上升； 　　一天之后的死亡率，患CKD病患，根据住院病历记录，血糖值低于50 mg/dl、50~59 mg/dl与60~69 mg/dl，血糖值70 mg/dl以上，校正后的勝算比為6.09、4.10与1.85，而沒有CKD患者，根據住院病歷記錄，為9.95、3.79與2.54。罹患CKD患者，根據出院後的記錄，校正後勝算比分別為6.84、3.28與3.98；而沒有CKD患者，根據出院後記錄，為13.28、7.36與4.34。　　　　　资深作者Jeffrey C. Fink在一篇新闻稿中表示，低血糖与一天后死亡率之间的关系强调了患糖尿病与慢性肾脏疾病病患代謝障碍的重要性。 Background and objectives: This study set out to determine the incidence of hypoglycemia in patients with chronic kidney disease (CKD), with and without diabetes, and the association of hypoglycemia with mortality. Design, setting, participants, & measurements: This was a retrospective cohort analysis of 243,222 patients who had 2,040,206 glucose measurements and were cared for at the Veterans Health Administration. CKD was defined as an estimated GFR of <60 ml/min per 1.73 m2. Hypoglycemia was set at <70 mg/dl. Mortality was measured 1 day after glucose measurement. Results: The incidence of hypoglycemia was higher in patients with CKD versus without CKD. Among patients with diabetes, the rate was 10.72 versus 5.33 per 100 patient-months and among patients without diabetes was 3.46 versus 2.23 per 100 patient-months, for CKD versus no CKD, respectively. The odds of 1-d mortality were increased at all levels of hypoglycemia but attenuated in CKD versus no CKD. Adjusted odds ratios for 1-d mortality that were associated with glucose values of <50, 50 to 59, and 60 to 69 mg/dl, respectively, versus glucose of 70 mg/dl were 6.09, 4.10, and 1.85 for inpatient records from patients with CKD; 9.95, 3.79, and 2.54 for inpatients records from patients without CKD; 6.84, 3.28, and 3.98 for outpatient records from patients with CKD