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采用口服葡萄糖耐量试验,胰岛素释放试验检测52例COPD急性发作期患者血糖及胰岛素水平,其中轻度低氧血症18例,中、重度低氧血症34例,静点地塞米松10mg/d5d的20例。结果:①中重度低氧血症者空腹血糖及血浆胰岛素水平明显增高,胰岛素敏感指数明显下降,与轻度低氧血症者相比有显著性差异(P<0.001,P<0.05,P<0.001),血糖与PO_2呈显著负相关(r=-0.5242,P<0.05)。②中、重度低氧血症者各时点血糖水平,葡萄糖曲线下面积均较轻度低氧血症者显著增高(P<0.05,P<0.001),两组耐糖曲线峰值均在糖负荷后1h。③胰岛素释放试验两组无显著性差异(P>0.05),但两组胰岛素释放时间均明显延长。④应用糖皮质激素治疗后,糖负荷后0.5h,1h血糖明显高于治疗前,耐糖曲线峰值提前,胰岛素释放试验各个时点释放量均明显高于治疗前,前后对比有显著性差异(P<0.05)。提示①COPD急性发作期合并低氧血症患者存在糖耐量减低和胰岛素抵抗。②应用糖皮质激素治疗使上述损害加重。
Oral glucose tolerance test and insulin release test were used to detect blood glucose and insulin levels in 52 patients with acute exacerbation of COPD. Among them, mild hypoxemia in 18 cases, moderate and severe hypoxemia in 34 cases, dexamethasone 10mg / d5d 20 cases. Results: (1) In moderate and severe hypoxemia, fasting blood glucose and plasma insulin levels were significantly increased and insulin sensitivity index was significantly decreased compared with mild hypoxemia (P <0.001, P <0.05, P < 0.001). There was a significant negative correlation between blood glucose and PO_2 (r = -0.5242, P <0.05). (2) The levels of blood glucose and the area under the curve of glucose in all the moderate and severe hypoxemia groups were significantly higher than those in the mild hypoxemia groups (P <0.05, P <0.001) 1h. ③ Insulin release test showed no significant difference between the two groups (P> 0.05), but the two groups were significantly longer insulin release. ④ After glucocorticoid treatment, the blood glucose at 0.5 h and 1 h after glucose loading was significantly higher than that before treatment, and the peak of glucose tolerance curve was earlier than that before treatment. The release of insulin at each time point was significantly higher than before treatment (P <0.05). Tip ① COPD acute exacerbation of hypoxemia in patients with impaired glucose tolerance and insulin resistance. ② glucocorticoid treatment to make the damage worse.