中华皮肤科杂志 ›› 2014, Vol. 47 ›› Issue (6): 381-384.

• 论著 •    下一篇

天疱疮和类天疱疮患者发生糖皮质激素诱导性糖尿病的风险和危险因素分析

孙祖凤1,顾宁琰2,周敏3,温志华4,陈京京1,姚煦5   

  1. 1. 中国医学科学院皮肤病医院
    2. 中国医学科学院北京协和医学院皮肤病研究所
    3. 南京，中国医学科学院皮肤病研究所
    4. 中国医学科学院皮肤病研究所
    5. 南京 中国医学科学院北京协和医学院皮肤病研究所
  • 收稿日期:2013-06-21 修回日期:2014-02-17 发布日期:2014-06-01
  • 通讯作者: 姚煦 E-mail:dryao_xu@126.com

Glucocorticoid-induced diabetes mellitus in patients with pemphigus or pemphigoid: prevalence and risk factors

  • Received:2013-06-21 Revised:2014-02-17 Published:2014-06-01

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摘要： 目的 探讨天疱疮和类天疱疮患者糖皮质激素诱导性糖尿病（GDM）的发生情况和相关危险因素。 方法 收集2011年12月至2013年1月接受糖皮质激素（激素）治疗的天疱疮和类天疱疮住院患者，比较发生GDM和未发生GDM两组患者的年龄、性别、体质指数（BMI）、病理类型、糖皮质激素的起始剂量、日激素最大剂量、糖尿病家族史、免疫抑制剂治疗等因素的差异。组间比较采用独立样本t检验，应用χ2检验和Fisher确切概率法对计数资料进行分析；用Logistic回归模型进行危险因素分析。 结果 经糖皮质激素治疗的68例天疱疮和类天疱疮患者中，26例（38.2%）发生了GDM。在发生和未发生糖尿病两组患者间进行单因素分析，结果显示：激素起始量（P < 0.05；OR 1.023；95% CI 1.002 ～ 1.044）、日激素最大剂量（P < 0.01；OR 1.037；95% CI 1.013 ～ 1.062）、激素治疗时间（P < 0.05；OR 1.143；95% CI 1.028 ～ 1.271）、BMI（P < 0.01；OR 1.265；95% CI 1.080 ～ 1.481）、地塞米松使用（P < 0.01；OR 6.0；95% CI 1.887 ～ 19.076）是天疱疮和类天疱疮患者发生GDM的危险因素。多因素Logistic回归分析显示：BMI（P < 0.05；OR 1.223；95% CI 1.017 ～ 1.471）和日激素最大剂量（P < 0.05；OR 1.037；95% CI 1.009 ～ 1.065）是GDM发生的独立危险因素。 结论 38.2%的天疱疮和类天疱疮患者经糖皮质激素治疗后发生了GDM，BMI和日激素最大剂量可能是GDM发生的独立危险因素。

关键词: 天疱疮, 类天疱疮，大疱性, 糖皮质激素, 糖尿病

Abstract: Sun Zufeng, Gu Ningyan, Zhou Min, Wen Zhihua, Chen Jingjing, Yao Xu. Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China Corresponding author: Yao Xu, Email: dryao_xu@126.com 【Abstract】 Objective To investigate the prevalence of and risk factors for glucocorticoid-induced diabetes mellitus（GDM） in patients with pemphigus or pemphigoid receiving glucocorticoid therapy. Methods This study included 68 hospitalized patients with pemphigus or pemphigoid receiving glucocorticoid therapy in the Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College from December 2011 to January 2013. Comparisons were carried out between patients with GDM and those without regarding multiple parameters, including age, sex, body mass index（BMI）, pathological type, initial dose and maximum daily dose of glucocorticoids, family history of diabetes mellitus, immunosuppressive treatment, etc. Independent samples t test was used for intergroup comparisons, Chi-square test and Fisher exact probability test for the analysis of count data, and a logistic regression model for the determination of risk factors. Results Among the 68 patients, 26 （38.2%） developed GDM during glucocorticoid therapy. Univariate logistic regression analysis showed that the initial dose of glucocorticoids （P < 0.05, OR 1.023, 95% CI 1.002 － 1.044）, maximum daily dose of glucocorticoids（P < 0.01, OR 1.037, 95% CI 1.013 － 1.062）, duration of glucocorticoid treatment （P < 0.05, OR 1.143, 95% CI 1.028 － 1.271）, BMI（P < 0.01, OR 1.265, 95% CI 1.080 － 1.481） and dexamethasone use（P < 0.01, OR 6.0, 95% CI 1.887 － 19.076） were risk factors for GDM in these patients. Multivariate logistic regression analysis showed that BMI（P < 0.05, OR 1.223, 95% CI 1.017 － 1.471） and maximum daily dose of glucocorticoids （P < 0.05, OR 1.037, 95% CI 1.009 － 1.065） were independent risk factors for GDM. Conclusions In this study, 38.2% of the patients with pemphigus or pemphigoid developed GDM during glucocorticoid therapy. BMI and maximum daily dose of glucocorticoids seem to be independent risk factors for GDM.

Key words: Pemphigus, Pemphigoid, bullous, Glucocorticoids, Diabetes mellitus

引用本文

孙祖凤 顾宁琰 周敏 温志华 陈京京 姚煦. 天疱疮和类天疱疮患者发生糖皮质激素诱导性糖尿病的风险和危险因素分析[J]. 中华皮肤科杂志, 2014,47(6):381-384. doi: