Healy Sara J, Nagaraja Haikady N, Alwan Dhuha, Dungan Kathleen M
Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center, 5th Floor McCampbell Hall, 1581 Dodd Drive, Columbus, OH, 43210-1296, USA.
Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH, 43210-1296, USA.
Endocrine. 2017 Apr;56(1):90-97. doi: 10.1007/s12020-016-1220-2. Epub 2017 Jan 6.
To determine prevalence, predictors, and outcomes of steroid-induced hyperglycemia in hospitalized patients with hematologic malignancies METHODS: We performed retrospective analysis of patients who were hospitalized on any of the four hematology services or bone marrow transplant service and who received systemic steroids during a 2-month period. Mean glucoses for days 1-4 and maximum glucose were calculated and the total daily steroid dose was converted to equivalent dose of dexamethasone. Hyperglycemia was defined as any glucose >9.917 mmol/l during days 1-4. We examined associations between variables using Spearman's correlations and multivariable linear regression RESULTS: 168 patients were included in the analysis. Mean age was 57.1 ± 14.4 years with 59% males and 90% Caucasians. The prevalence of hyperglycemia was 39%. Eight patients received intravenous insulin. In patients without diabetes, steroid dose equivalent to >12 mg dexamethasone and longer acting steroids caused greater degree of hyperglycemia compared to a dose <12 mg. Maximum glucose was a predictor of hospital length of stay among patients without diabetes (but not those with diabetes), and with acute leukemia or stem cell transplant (but not other hematologic malignancies). There were no significant differences in in mortality or other outcomes between the groups with and without hyperglycemia CONCLUSIONS: Hyperglycemia is common in patients with hematologic malignancies, which require frequent corticosteroids. Higher steroid dose and long-acting steroids caused a greater degree of hyperglycemia. Maximum glucose was a predictor of length of stay but this was only significant for patients without diabetes, those with acute hematologic malignancy or stem cell transplant.
确定血液系统恶性肿瘤住院患者中类固醇诱导的高血糖症的患病率、预测因素及预后 方法：我们对在四个血液科服务科室或骨髓移植科室住院且在2个月期间接受全身类固醇治疗的患者进行了回顾性分析。计算第1 - 4天的平均血糖值和最高血糖值，并将每日类固醇总剂量换算为地塞米松等效剂量。高血糖症定义为第1 - 4天任何血糖值>9.917 mmol/l。我们使用Spearman相关性分析和多变量线性回归分析变量之间的关联 结果：168例患者纳入分析。平均年龄为57.1±14.4岁，男性占59%，白种人占90%。高血糖症患病率为39%。8例患者接受了静脉胰岛素治疗。在无糖尿病患者中，与剂量<12 mg相比，等效剂量>12 mg地塞米松的类固醇及长效类固醇导致更高程度的高血糖症。最高血糖值是无糖尿病患者（而非糖尿病患者）、急性白血病或干细胞移植患者（而非其他血液系统恶性肿瘤患者）住院时间的预测因素。高血糖组和非高血糖组在死亡率或其他预后方面无显著差异 结论：血液系统恶性肿瘤患者中高血糖症常见，这些患者常需要使用皮质类固醇。更高的类固醇剂量和长效类固醇导致更高程度的高血糖症。最高血糖值是住院时间的预测因素，但仅对无糖尿病患者、急性血液系统恶性肿瘤患者或干细胞移植患者有显著意义。
