目的 分析维持性血液透析(maintenance hemodialysis,MHD)患者透析中血糖变化规律、低血糖发生情况及其相关影响因素，并探讨含糖透析液(glucose-containing dialysate,GCD)对透析中低血糖的影响。 方法 纳入2021年12月～2022年12月于吉林大学第二医院血液净化中心MHD的患者，常规使用无糖透析液(glucose-free dialysate,GFD)，后改用5.5 mmol/L葡萄糖的GCD，测量GFD末次及GCD治疗第4次透析开始、1h、2h、3h及透析结束时的血糖，分析比较糖尿病(diabetes mellitus,DM)和非DM患者透析中血糖变化规律及低血糖发生情况，并采用单因素及多因素Logistic回归分析DM患者透析中低血糖发生的影响因素。 结果 共纳入MHD患者232例，DM组102例和非DM组130例。GFD治疗时，DM组(非DM组)21例(6例)发生低血糖，透析0～2 h发生3次(0次)，2 h～结束发生21次(6次),无症状低血糖占比79.17%(83.33%)。DM组与非DM组低血糖发生率差异有统计学意义(20.59%比4.62%，c2=14.180，P＜0.001)。改用GCD治疗后,DM患者仅1例出现了低血糖，低血糖发生率为0.98%，低于使用GFD时低血糖的发生率(0.98% 比20.59%，P＜0.001)；非DM患者未发生低血糖。透析前血糖水平≥10 mmol/L(OR=0.185，95% CI：0.054～0.636，P=0.007)、透析日减停降糖药物(OR=0.226，95% CI：0.073～0.707，P=0.011)是透析中低血糖发生的保护性因素，糖尿病病程≥20年(OR=3.280，95% CI：1.046～10.286，P=0.042)是透析中低血糖发生的危险因素。 结论 透析2h至透析结束是MHD患者低血糖的好发时段，且以无症状低血糖为主；葡萄糖浓度5.5 mmol/L的GCD可有效减少低血糖的发生。DM病程≥20年是透析中低血糖的危险因素，透析日减停降糖药物、透析前血糖水平≥10 mmol/L是透析中低血糖的保护性因素。
Objectives To analyze the rules and influencing factors of intradialytic blood glucose change and hypoglycemia, and to explore the effect of glucose-containing dialysate (GCD) on intradialytic hypoglycemia. Methods The maintenance hemodialysis (MHD) patients treated in the Blood Purification Center, The Second Hospital of Jilin University from December 2021 to December 2022 were enrolled in this study. They were routinely treated with glucose-free dialysate (GFD), and then switched to GCD containing 5.5mmol/L glucose. Blood glucose was assayed at 0, 1st， 2nd, 3rd hour and the end of last session of hemodialysis with GFD, and of the 4th session of hemodialysis with GCD. Intradialytic blood glucose changes and hypoglycemia were compared between the MHD patients with and without diabetes. Univariate and multivariate logistic regression were used to analyze the influencing factors for intradialytic hypoglycemia in MHD patients with diabetes. Results A total of 232 MHD patients were enrolled in this study, including 102 in diabetes group and 130 in non-diabetes group. When they were dialyzed with GFD, hypoglycemia occurred in 21 cases in diabetes group (3 episodes of hypoglycemia occurred during dialysis after 0~2 hour and 21 episodes occurred during dialysis after 2 hours to end of the session), and in 6 cases in non-diabetes group (6 episodes occurred during dialysis after 2 hours to end of the session). Asymptomatic hypoglycemia accounted for 79.17% and 83.33% of the hypoglycemia in diabetes group and non-diabetes group respectively. The incidences of hypoglycemia were 20.59 % and 4.62% in diabetes group and non-diabetes group respectively (c2=14.180, P＜0.001). After the hemodialysis switched to GCD, hypoglycemia occurred in one case (0.98%) in diabetes group, significantly lower than the incidence of 20.59 % when GFD was used (P＜0.001); no hypoglycemia occurred in non-diabetes group. Pre-dialytic blood glucose≥10mmol/L (OR=0.185, 95% CI 0.054~0.636, P=0.007) and withdrawal of hypoglycemic medications on dialysis day (OR=0.226, 95% CI 0.073~0.707, P=0.011) were the protective factors for intradialytic hypoglycemia, while diabetes course≥20 years (OR=3.280, 95% CI 1.046~10.286,P=0.042) was the risk factor for intradialytic hypoglycemia. Conclusion The last 2 hours of a dialysis session is the period when hypoglycemia, especially asymptomatic hypoglycemia, frequently occurs. GCD with a glucose concentration of 5.5mmol/L can effectively reduce the prevalence of hypoglycemia. Diabetes course ≥20 years is the risk factor for intradialytic hypoglycemia; withdrawal of hypoglycemic medications on dialysis day and pre-dialytic blood glucose ≥10mmol/L are the protective factors for intradialytic hypoglycemia.
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