【摘要】：目的分析淋巴瘤患者在化療過程中出現(xiàn)繼發(fā)糖尿病的發(fā)生率及相關(guān)因素,探索化療后出現(xiàn)繼發(fā)糖尿病的危險因素。方法收集我院從2011年1月至2015年12月期間收治的住院接受化療的淋巴瘤患者,共計(jì)207例,其中21例患者化療前有糖尿病病史或糖尿病家族史,最終將符合條件的且臨床資料完整的186例淋巴瘤患者的納入本次研究。186例患者均無糖尿病家族史,化療前也無糖尿病病史及血糖升高情況。其中,男性患者共92例(49.5%),女性患者共94例(50.5%);40歲及以上的患者共135例(72.5%),40歲以下的患者共51例(27.5%)。根據(jù)糖尿病的診斷標(biāo)準(zhǔn),對化療后患者血糖情況進(jìn)行統(tǒng)計(jì),分析淋巴瘤患者化療后出現(xiàn)繼發(fā)糖尿病的發(fā)生率。并根據(jù)血糖情況將其分為2組:化療后繼發(fā)糖尿病組和血糖正常組。比較分析兩組患者的一般特征,分別對兩組患者的年齡、性別、病理分型、臨床分期、B癥狀、4~6療程化療后評估是否完全反應(yīng)(CR,complete response)等進(jìn)行l(wèi)ogistic回歸分析。首先,通過單因素logistic回歸分析,篩選出化療繼發(fā)糖尿病的可能相關(guān)因素。然后,在對這些可能的相關(guān)因素進(jìn)行多因素logistic回歸分析,探索化療后出現(xiàn)繼發(fā)糖尿病的危險因素。結(jié)果186例淋巴瘤患者中,有48例(25.8%)患者化療后出現(xiàn)繼發(fā)糖尿病。化療繼發(fā)糖尿病的發(fā)生率為25.8%。單因素分析顯示:年齡≥40歲、有B癥狀、首次未完全反應(yīng)是化療繼發(fā)糖尿病的相關(guān)危險因素。而未得出性別、臨床分期、病理類型與化療繼發(fā)糖尿病相關(guān),因此不是繼發(fā)糖尿病的危險因素。通過單因素分析得出的相關(guān)危險因素:年齡、B癥狀、首次未完全反應(yīng)再進(jìn)行l(wèi)ogistic多因素回歸分析,結(jié)果顯示:40歲以上淋巴瘤患者化療后發(fā)生繼發(fā)糖尿病的風(fēng)險是40歲以下患者出現(xiàn)繼發(fā)糖尿病的風(fēng)險的9.2倍(OR=9.200),有B癥狀的患者發(fā)生繼發(fā)糖尿病的風(fēng)險是無B癥狀患者的2.9倍(OR=2.903),4~6療程化療后評估,首次未完全反應(yīng)患者發(fā)生繼發(fā)糖尿病的風(fēng)險是首次完全反應(yīng)的2.08倍(OR=2.080)。結(jié)論繼發(fā)糖尿病是淋巴瘤患者化療期間的重要并發(fā)癥,發(fā)生率為25.8%。其中,年齡≥40、B癥狀、首次未完全反應(yīng)為化療繼發(fā)糖尿病的獨(dú)立危險因素。繼發(fā)糖尿病作為化療的重要并發(fā)癥之一,已引起越來越多臨床醫(yī)生的重視�；熇^發(fā)糖尿病影響患者的生存和預(yù)后,因此,在化療過程中應(yīng)加強(qiáng)化療后患者血糖水平的監(jiān)測和糖尿病癥狀的關(guān)注,尤其是對于年齡≥40歲、出現(xiàn)B癥狀、化療后評估,首次未完全反應(yīng)的淋巴瘤患者。對于出現(xiàn)糖尿病癥狀及血糖水平異常的患者,及時采取有效措施控制血糖水平,以降低患者在化療過程中出現(xiàn)血糖升高的發(fā)生幾率,保證化療順利進(jìn)行,減少糖尿病并發(fā)癥的發(fā)生,提高患者生活質(zhì)量,延長生存期。
[Abstract]:Objective to analyze the incidence and related factors of secondary diabetes mellitus in lymphoma patients during chemotherapy, and to explore the risk factors of secondary diabetes mellitus after chemotherapy. Methods A total of 207 patients with chemotherapeutic lymphoma were collected from January 2011 to December 2015 in our hospital. Among them, 21 patients had a history of diabetes or a family history of diabetes before chemotherapy. 186 cases of lymphoma patients with complete clinical data were included in this study. 186 patients had no family history of diabetes, no history of diabetes and elevated blood glucose before chemotherapy. Among them, 92 cases (49.5%) were male, 94 cases (50.5%) were female, 135 cases (72.5%) were over 40 years old, 51 cases (27.5%) were under 40 years old. According to the diagnostic criteria of diabetes, the incidence of secondary diabetes in lymphoma patients after chemotherapy was analyzed. The patients were divided into two groups according to their blood glucose status: secondary diabetes after chemotherapy and normal blood glucose. The general characteristics of the two groups were compared and analyzed. The age, sex, pathological type, clinical stage, B symptom and CR,complete response after 4 courses of chemotherapy were analyzed by logistic regression analysis. First, univariate logistic regression analysis was used to screen the possible risk factors for diabetes secondary to chemotherapy. Then, multivariate logistic regression analysis was carried out to explore the risk factors of secondary diabetes after chemotherapy. Results among 186 cases of lymphoma, 48 cases (25.8%) developed secondary diabetes after chemotherapy. The incidence of diabetes secondary to chemotherapy was 25. 8%. Univariate analysis showed that age 鈮，

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