生玉米淀粉在胰岛素瘤相关低血糖症中的疗效：一种有前景的支持性治疗方法。

Efficacy of Raw Corn Starch in Insulinoma-Related Hypoglycemia: A Promising Supportive Therapy.

机构信息

Department of Clinical Nutrition, Beijing Key Laboratory of the Innovative Development of Functional Staple and the Nutritional Intervention for Chronic Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.

Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.

出版信息

Chin Med Sci J. 2024 Jun 30;39(2):102-110. doi: 10.24920/004329.

DOI:10.24920/004329

PMID:38755752

Abstract

Objective To investigate the efficacy of raw corn starch (RCS) in clinical management of insulinoma-induced hypoglycemia. Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively, and analyzed the therapeutic effects of the RCS intervention on blood glucose control, weight change, and its adverse events. Results The study population consisted of 24 cases of insulinoma patients, 7 males and 17 females, aged 46.08±14.15 years. Before RCS-supplemented diet, all patients had frequent hypoglycemic episodes (2.51±3.88 times/week), concurrent with neuroglycopenia (in 83.3% of patients) and autonomic manifestations (in 75.0% of patients), with the median fasting blood glucose (FBG) of 2.70 (interquartile range [IQR]: 2.50-2.90) mmol/L. The patients' weight increased by 0.38 (IQR: 0.05-0.65) kg per month, with 8 (33.3%) cases developing overweight and 7 (29.2%) cases developing obesity. All patients maintained the RCS-supplemented diet until they underwent tumor resection (23 cases) and transarterial chemoembolization for liver metastases (1 case). For 19 patients receiving RCS throughout the day, the median FBG within one week of nutritional management was 4.30 (IQR: 3.30-5.70) mmol/L, which was a significant increase compared to pre-nutritional level [2.25 (IQR: 1.60-2.90) mmol/L; < 0.001]. Of them, 10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment [3.20 (IQR: 2.60-3.95) mmol/L . 2.15 (IQR: 1.83-2.33) mmol/L; < 0.001). Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management [3.50 (IQR: 2.50-3.65) mmol/L . 2.20 (IQR:1.80-2.60) mmol/L; < 0.001], but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG. No improvement in weight gain was observed upon RCS supplementation. Mild diarrhea (2 cases) and flatulence (1 case) occurred, and were relieved by reduction of RCS dose. Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.

摘要

目的探讨生玉米淀粉（RCS）在胰岛素瘤相关低血糖症临床管理中的疗效。

方法我们回顾性收集了术前接受 RCS 补充饮食的胰岛素瘤患者的临床资料，并分析了 RCS 干预对血糖控制、体重变化及其不良反应的治疗效果。

结果研究人群包括 24 例胰岛素瘤患者，男性 7 例，女性 17 例，年龄 46.08±14.15 岁。在接受 RCS 补充饮食之前，所有患者均有频繁的低血糖发作（2.51±3.88 次/周），同时伴有神经低血糖（83.3%的患者）和自主神经表现（75.0%的患者），空腹血糖（FBG）中位数为 2.70（四分位距[IQR]：2.50-2.90）mmol/L。患者每月体重增加 0.38（IQR：0.05-0.65）kg，超重 8 例（33.3%），肥胖 7 例（29.2%）。所有患者均维持 RCS 补充饮食，直至接受肿瘤切除术（23 例）或肝转移经动脉化疗栓塞术（1 例）。对于 19 例全天接受 RCS 的患者，营养管理后一周内的 FBG 中位数为 4.30（IQR：3.30-5.70）mmol/L，与营养前水平相比显著升高[2.25（IQR：1.60-2.90）mmol/L； < 0.001]。其中，10 例全天接受 RCS 治疗超过四周的患者与治疗前相比 FBG 持续改善[3.20（IQR：2.60-3.95）mmol/L；2.15（IQR：1.83-2.33）mmol/L； < 0.001]。5 例仅在夜间接受 RCS 的患者营养管理后一周内 FBG 也显著升高[3.50（IQR：2.50-3.65）mmol/L；2.20（IQR：1.80-2.60）mmol/L； < 0.001]，但仅有 1 例继续接受 RCS 治疗超过四周的患者 FBG 无显著改善。RCS 补充并未观察到体重增加的改善。轻微腹泻（2 例）和腹胀（1 例），减少 RCS 剂量后缓解。

结论 RCS 补充饮食对控制胰岛素瘤相关低血糖症有效。