Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, Medicine, The University of New South Wales, Randwick, NSW, Australia; Molecular and Integrative Cystic Fibrosis Research Centre (miCF_RC), Sydney, Australia.
School of Women's and Children's Health, Medicine, The University of New South Wales, Randwick, NSW, Australia.
J Cyst Fibros. 2020 Mar;19(2):305-309. doi: 10.1016/j.jcf.2019.05.005. Epub 2019 May 22.
BACKGROUND: Screening for Cystic Fibrosis-related diabetes is recommended in patients with CF <10 years old when there are concerns about growth and lung function. The Oral Glucose Tolerance Test (OGTT) is recommended but has not been validated in this cohort. We sought to determine whether the 2-h OGTT, the gold standard diagnostic test for CFRD, detects clinical decline in children with CF <10 years old. METHODS: We analysed blood glucose(BG) levels collected every 30 min during OGTT in 27 children with CF < 10 years old, comparing the 2-hour BG (BG), peak BG (BG) and Area Under the Curve(AUC) for glucose and the association with lung function and nutritional status. We also compared the OGTT results with results from Continuous Glucose Monitoring (CGM) performed in 11 participants. RESULTS: The BG was higher than the BG in 25/27 (93%) participants. There was a significant inverse correlation between BG and weight z-score (r = -0.56, p = .002) and between BG and FEV (r = -0.54, p = .014) that was not present for BG. A significant inverse correlation was also identified between fasting insulin level and elevated glucose on CGM, defined as AUC >7.8 mmol/L (r - 0.69, p = .027) or as % time > 7.8 (r = - 0.76, p = .011). CONCLUSIONS: Children with CF < 10 years of age with higher BG on OGTT have lower lung function and weight z- scores that may not be identified using the 2 h OGTT BG. CGM also identifies glucose excursions in young children with CF.
背景：当 CF 患者有生长和肺功能方面的担忧时，建议对 <10 岁的 CF 患者进行囊性纤维化相关糖尿病（Cystic Fibrosis-related diabetes，CFRD）筛查。推荐使用口服葡萄糖耐量试验（Oral Glucose Tolerance Test，OGTT），但尚未在该队列中得到验证。我们旨在确定 2 小时 OGTT 是否可检测出 <10 岁 CF 患儿的临床衰退。
方法：我们分析了 27 名 <10 岁 CF 患儿 OGTT 过程中每 30 分钟采集的血糖（Blood Glucose，BG）水平，比较了 2 小时 BG（BG）、峰值 BG（BG）和血糖曲线下面积（Area Under the Curve，AUC）与肺功能和营养状况的相关性。我们还将 OGTT 结果与 11 名参与者的连续血糖监测（Continuous Glucose Monitoring，CGM）结果进行了比较。
结果：27 名参与者中有 25 名（93%）的 BG 高于 BG。BG 与体重 z 评分呈显著负相关（r = -0.56，p = 0.002），与 FEV 呈显著负相关（r = -0.54，p = 0.014），但 BG 与 FEV 无相关性。空腹胰岛素水平与 CGM 上的高血糖（定义为 AUC >7.8mmol/L，r = -0.69，p = 0.027；或 %时间>7.8，r = -0.76，p = 0.011）之间也存在显著的负相关。
结论：在 OGTT 中 BG 较高的 <10 岁 CF 患儿，其肺功能和体重 z 评分较低，而这些可能无法通过 2 小时 OGTT BG 检测出来。CGM 还可识别 CF 幼儿的血糖波动。
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