Guelho Daniela, Paiva Isabel, Carrilho Francisco
Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal..
Acta Med Port. 2014 Mar-Apr;27(2):196-203. Epub 2014 Apr 30.
In type 2 diabetic patients treated with metformin the development of hyperlactacidemia or even lactic acidosis seems to result from an acute precipitating event. This study aims to assess the prevalence and relative risk of hyperlactacidemia in diabetic patients admitted in the Emergency Room, the predictive factors for high lactate concentration and the influence of hyperlactacidemia in patients' prognosis.
Transversal observational study including patients observed between June and October 2012: 138 type 2 diabetics, 66 treated with metformin, and 83 non-diabetic patients. Studies' variables: age, sex, cause of admition, blood pressure, drugs, personal history, analytical study (biochemistry and arterial blood gas analyses with lactate) and destination. Statistical analysis was performed using SPSS 21.0(®).
Mean lactate concentration and hyperlactacidemia prevalence were significantly higher in diabetic patients (2.1 ± 0.1 mmol/L vs 1.1 ± 0.1 mmol/L, p < 0.001 and 39.1% vs 3.6%, p < 0.001, respectively) and in those under metformin compared to other diabetics (2.7 ± 0.2 mmol/L vs 1.6 ± 0.1 mmol/L, p < 0.001 and 56.9% vs 23.3%, p < 0.001, respectively). Diabetics on metformin presented a 25-fold increased risk of hyperlactacidemia (OR = 25.10, p < 0.05). Creatinine was the only independent predictive factor for lactate concentrations (B = 1.33, p < 0.05). Patients with hyperlactacidemia had 4.4 times higher odds of being hospitalized or dying (OR = 4.37, p < 0.05). When hospitalized, they had longer hospitalization periods (21.66 ± 5.86 days vs 13.68 ± 5.33 days, p < 0.001) and higher rate of deaths (12.5% (n = 4) vs 4.3% (n = 2), p < 0.05).
There was an increased risk of hyperlactacidemia in patients with type 2 diabetes, particularly for those under metformin. Serum creatinine represented the only independent associated factor of lactate concentration. The presence of hyperlactacidemia was associated with worse prognosis.
在接受二甲双胍治疗的2型糖尿病患者中，高乳酸血症甚至乳酸性酸中毒的发生似乎源于急性诱发事件。本研究旨在评估急诊室收治的糖尿病患者中高乳酸血症的患病率和相对风险、高乳酸浓度的预测因素以及高乳酸血症对患者预后的影响。
横向观察性研究，纳入2012年6月至10月间观察的患者：138例2型糖尿病患者，其中66例接受二甲双胍治疗，83例非糖尿病患者。研究变量：年龄、性别、入院原因、血压、药物、个人史、分析性研究（生化及动脉血气分析检测乳酸）及转归。使用SPSS 21.0(®)进行统计分析。
糖尿病患者的平均乳酸浓度和高乳酸血症患病率显著高于非糖尿病患者（分别为2.1±0.1 mmol/L对1.1±0.1 mmol/L，p<0.001；39.1%对3.6%，p<0.001），接受二甲双胍治疗的糖尿病患者与其他糖尿病患者相比也是如此（分别为2.7±0.2 mmol/L对1.6±0.1 mmol/L，p<0.001；56.9%对23.3%，p<0.001）。接受二甲双胍治疗的糖尿病患者发生高乳酸血症的风险增加25倍（OR=25.10，p<0.05）。肌酐是乳酸浓度的唯一独立预测因素（B=1.33，p<0.05）。高乳酸血症患者住院或死亡的几率高4.4倍（OR=4.37，p<0.05）。住院时，他们的住院时间更长（21.66±5.86天对13.68±5.33天，p<0.001），死亡率更高（12.5%（n=4）对4.3%（n=2），p<0.05）。
2型糖尿病患者发生高乳酸血症的风险增加，尤其是接受二甲双胍治疗的患者。血清肌酐是乳酸浓度的唯一独立相关因素。高乳酸血症的存在与较差的预后相关。
