Kilby J M, Tabereaux P B
Department of Medicine, University of Alabama at Birmingham, 35294-2050, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Jan 1;17(1):46-50. doi: 10.1097/00042560-199801010-00007.
We determined the frequency and clinical nature of severe hyperglycemia in a university clinic for HIV-1-infected patients. The medical records of 1392 adult HIV-infected patients were reviewed for cases of severe hyperglycemia, defined as two or more serum glucose values >250 mg/dl or diabetes treatment during clinic care. Demographic information, family histories of diabetes mellitus, body weights, CD4+ lymphocyte counts, and use of corticosteroids, megestrol acetate, pentamidine, or didanosine were recorded for subjects meeting the case definition. Comparisons were made between preexisting diabetic (group 1) and incident hyperglycemic cases (group 2). Less than 2% of the total clinic population experienced severe hyperglycemia: 12 in group 1 and 13 in group 2. Group 2 had lower body weights (mean, 70.6 kg versus 90.0 kg; p < 0.05) and more advanced HIV disease (mean CD4 count, 79/mm3 versus 550/mm3; p < 0.05) than group 1. Group 2 cases had evidence of drug-associated hyperglycemia; four cases demonstrated hyperglycemia coinciding with large fluctuations in weight during megestrol therapy. Among megestrol recipients, cases did not differ from noncases in demographics, weight, or CD4 count. Severe hyperglycemia is uncommon in adult HIV-infected patients. Approximately one half of these patients have preexisting diabetic conditions; many of the remainder may have drug-induced hyperglycemia, especially as a result of corticosteroids or megestrol acetate.
我们在一家大学诊所对感染HIV-1的患者中严重高血糖的发生率及临床特征进行了测定。回顾了1392例成年HIV感染患者的病历，以查找严重高血糖病例，严重高血糖定义为在门诊护理期间两次或更多次血清葡萄糖值>250mg/dl或接受糖尿病治疗。记录了符合病例定义的受试者的人口统计学信息、糖尿病家族史、体重、CD4+淋巴细胞计数以及皮质类固醇、醋酸甲地孕酮、喷他脒或去羟肌苷的使用情况。对已患糖尿病患者（第1组）和新发高血糖病例（第2组）进行了比较。诊所总人群中严重高血糖的发生率不到2%：第1组有12例，第2组有13例。第2组的体重低于第1组（平均70.6kg对90.0kg；p<0.05），HIV疾病进展程度更高（平均CD4计数，79/mm³对550/mm³；p<0.05）。第2组病例有药物相关性高血糖的证据；4例在醋酸甲地孕酮治疗期间血糖升高与体重大幅波动同时出现。在接受醋酸甲地孕酮治疗的患者中，病例与非病例在人口统计学、体重或CD4计数方面无差异。严重高血糖在成年HIV感染患者中并不常见。这些患者中约有一半患有糖尿病；其余许多患者可能患有药物性高血糖，尤其是由于皮质类固醇或醋酸甲地孕酮所致。
