Martín-Frías M, Lamas Ferreiro A, Enes Romero P, Cano Gutiérrez B, Barrio Castellanos R
Unidad de Diabetes Pediátrica, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
An Pediatr (Barc). 2012 Nov;77(5):339-43. doi: 10.1016/j.anpedi.2012.05.015. Epub 2012 Jun 27.
Annual screening for abnormal glucose tolerance (AGT) with oral glucose test should begin by age 10 years in cystic fibrosis (CF) patients (Consensus-2010).
To examine the frequency of AGT and its outcome in prepubertal CF patients and the changes in glycemic and nutritional status and lung function over the preceding year.
Retrospective study of 19 prepubertal CF patients (68% males). All subjects underwent an oral glucose tolerance test (OGTT). Results were classified as: normal glucose tolerance (NGT) or AGT (impaired glucose tolerance [IGT], CF related diabetes [CFRD] or indeterminate glucose tolerance [INDET]). We analyzed: OGTT (glucose and insulin levels), nutritional status (BMI-SD) and lung function (forced spirometry). Statistical analysis was performed with SPSS program-version-15.0, non parametric tests.
Mean age at first OGGT: 8.5 years (5.8-9.8). Mean follow-up: 2 years (2-3). Initially, 47% patients had AGT and 53% NGT. In follow-up: 4/10 NGT patients developed AGT (3 IGT, 1 CFRD). Among initial AGT patients, of 4 INDET: 2 developed IGT, 1 CFRD. Mean age of AGT onset: 8.6 years (6.4-11.1). In 69% AGT patients a declining BMI-DS and/or lung function was found in the preceding year. In OGTTs performed, fasting and 2h AUC insulin levels were comparable between NGT and AGT; however, insulinogenic index was lower in AGT patients (p=.006). Insulin secretion was delayed in all patients.
The high frequency of AGT in prepubertal CF patients and their negative clinical impact supports the usefulness of an earlier glycemic screening.
对于囊性纤维化（CF）患者，应在10岁开始每年通过口服葡萄糖试验筛查糖耐量异常（AGT）（2010年共识）。
研究青春期前CF患者中AGT的发生率及其结果，以及前一年血糖、营养状况和肺功能的变化。
对19例青春期前CF患者（68%为男性）进行回顾性研究。所有受试者均接受口服葡萄糖耐量试验（OGTT）。结果分为：正常糖耐量（NGT）或AGT（糖耐量受损[IGT]、CF相关糖尿病[CFRD]或糖耐量不确定[INDET]）。我们分析了：OGTT（血糖和胰岛素水平）、营养状况（BMI-SD）和肺功能（用力肺活量测定）。使用SPSS 15.0版程序进行统计分析，采用非参数检验。
首次OGGT的平均年龄为8.5岁（5.8 - 9.8岁）。平均随访时间为2年（2 - 3年）。最初，47%的患者有AGT，53%为NGT。在随访中：10例NGT患者中有4例发展为AGT（3例IGT，1例CFRD）。在最初的AGT患者中，4例INDET中有2例发展为IGT，1例发展为CFRD。AGT发病的平均年龄为8.6岁（6.4 - 11.1岁）。在69%的AGT患者中，前一年发现BMI-DS和/或肺功能下降。在进行的OGTT中，NGT和AGT患者的空腹和2小时AUC胰岛素水平相当；然而，AGT患者的胰岛素生成指数较低（p = 0.006）。所有患者的胰岛素分泌均延迟。
青春期前CF患者中AGT的高发生率及其负面临床影响支持早期血糖筛查的有效性。
