口服二甲双胍的 2 型糖尿病门诊老年患者的空腹血浆乳酸浓度：一项回顾性横断面研究。

Fasting plasma lactate concentrations in ambulatory elderly patients with type 2 diabetes receiving metformin therapy: a retrospective cross-sectional study.

机构信息

Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan, R.O.C.

出版信息

J Chin Med Assoc. 2010 Dec;73(12):617-22. doi: 10.1016/S1726-4901(10)70135-0.

DOI:10.1016/S1726-4901(10)70135-0

PMID:21145508

Abstract

BACKGROUND

Metformin is a worldwide accepted biguanide antidiabetic agent, and its effectiveness and benefit have already been well established. Among the side effects of metformin, lactate acidosis is the most problematic because of a high mortality rate, which impedes its use in clinical practice, especially in elderly patients with type 2 diabetes. Aging is associated with a decreased renal function and increasing comorbidities, but few data are available regarding plasma lactate levels in this unique population. In this study, we assessed fasting plasma lactate levels in ambulatory, elderly Taiwanese patients with type 2 diabetes, who were taking the drug, metformin, to identify independent risk factors for hyperlactemia in this group.

METHODS

Sixty-six ambulatory type 2 diabetic patients, > 80 years of age (mean, 83.6 years; range, 80-90 years), receiving metformin therapy, were enrolled, from January 2005 to September 2009, in the Diabetes Case Management Program. A further 79 younger patients (also type 2 diabetics on metformin) served as controls (mean age, 59.9 years; range, 37-79 years). Fasting serum electrolytes, creatinine, bicarbonate, glycated hemoglobin, plasma glucose and lactate levels were determined.

RESULTS

Lactate levels did not differ between the elderly and control groups (13.2 +/- 5.2 mg/dL and 13.5 +/- 4.8 mg/dL, respectively). None of the patients fulfilled the lactic acidosis criteria. Patients in the elderly group had a significantly lower daily metformin dose, higher creatinine levels, and lower estimated creatinine clearance, compared with the control group (all p < 0.05). Estimated creatinine clearance was negatively associated with lactate levels in the elderly group (p < 0.05, r = -0.27), but not in the control group. Patients with fasting plasma glucose levels > 130 mg/dL had a 2.8-fold increased risk of developing hyperlactemia.

CONCLUSION

Plasma lactate levels in ambulatory elderly patients with type 2 diabetes receiving metformin therapy did not differ from those in a younger age group. Patients with fasting plasma glucose levels > 130 mg/dL had a 2.8-fold risk of developing hyperlactemia, but none of them developed lactate acidosis.

摘要

背景

二甲双胍是一种被全球认可的双胍类抗糖尿病药物，其疗效和益处已得到充分证实。在二甲双胍的副作用中，乳酸酸中毒是最成问题的，因为其死亡率很高，这阻碍了它在临床实践中的应用，尤其是在患有 2 型糖尿病的老年患者中。衰老与肾功能下降和合并症增加有关，但关于这一独特人群的血浆乳酸水平的数据很少。在这项研究中，我们评估了服用二甲双胍的 66 名门诊老年 2 型糖尿病患者的空腹血浆乳酸水平，以确定该组患者发生高乳酸血症的独立危险因素。

方法

2005 年 1 月至 2009 年 9 月，我们招募了 66 名年龄在 80 岁以上（平均 83.6 岁；范围 80-90 岁）、正在服用二甲双胍的门诊 2 型糖尿病患者，参加糖尿病病例管理计划。另外 79 名较年轻的患者（也在服用二甲双胍的 2 型糖尿病患者）作为对照组（平均年龄 59.9 岁；范围 37-79 岁）。测定空腹血清电解质、肌酐、碳酸氢盐、糖化血红蛋白、血糖和乳酸水平。

结果

老年组和对照组的乳酸水平无差异（分别为 13.2±5.2 mg/dL 和 13.5±4.8 mg/dL）。没有患者符合乳酸酸中毒的标准。与对照组相比，老年组患者的每日二甲双胍剂量明显较低，肌酐水平较高，估计肌酐清除率较低（均 p<0.05）。老年组的估计肌酐清除率与乳酸水平呈负相关（p<0.05，r=-0.27），但在对照组中无此相关性。空腹血糖水平>130 mg/dL 的患者发生高乳酸血症的风险增加 2.8 倍。