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Changes in Postoperative Blood Glucose and the Predictive Factors in Patients with Pheochromocytoma Complicated with Type 2 Diabetes
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摘要:
目的 观察嗜铬细胞瘤并发2型糖尿病患者术后血糖变化, 分析术后糖尿病缓解的预测因素。 方法 回顾性收集2012年1月至2016年12月在四川大学华西医院泌尿外科住院接受手术治疗的嗜铬细胞瘤并发2型糖尿病患者的临床资料, 将性别、年龄、体质量指数(body mass index, BMI)、肿瘤直径、术前儿茶酚胺水平、术前术后的降糖方案和空腹血糖等变量纳入分析。术后糖尿病缓解定义为术后停用/减少降糖药物或空腹血糖≤ 6.1 mmol/L, 根据术后糖尿病是否缓解将患者分为缓解组与未缓解组, 采用单因素Logistic回归模型分析术后糖尿病缓解的相关预测因素。 结果 27例随访资料完整的嗜铬细胞瘤并发2型糖尿病患者入选本研究, 其中男性8例, 女性19例, 平均年龄(51±9)岁。患者术后空腹血糖较术前显著降低[(5.14±1.37)mmol/L比(8.68±5.94)mmol/L, P < 0.01]。术后糖尿病总体缓解率为78%(21/27), 未缓解率为22%(6/27)。单因素Logistic回归分析显示, 年龄、性别、BMI、肿瘤直径、术前血浆儿茶酚胺均与术后糖尿病缓解无关(P均>0.05)。 结论 嗜铬细胞瘤并发2型糖尿病患者接受根治术后, 糖尿病病情较术前明显缓解。年龄、性别、BMI、肿瘤直径、术前血儿茶酚胺水平均非术后糖尿病缓解的预测因素。 Abstract:Objective We aimed to observe the changes in postoperative blood glucose of patients with pheochromocytoma complicated with type 2 diabetes and explore the potential predictive factors for the postoperative remission of diabetes. Methods Preoperative and follow-up information of patients with pheochromocytoma complicated with type 2 diabetes who underwent the surgery of radical resection in West China Hospital from January 2012 to December 2016 was retrospectively collected and analyzed. Analyzed variables included age, sex, body mass index (BMI), tumor diameter, preoperative blood catecholamine, preoperative and postoperative hypoglycemic regimen, and fasting blood glucose. Postoperative remission of diabetes was defined as discontinuing/reducing of hypoglycemic drugs or fasting blood glucose ≤ 6.1 mmol/L. According to with or without remission, the patients were divided into two groups:remission group and non-remission group. The predictive factors for remission were analyzed by single-variable Logistic regression analysis. Results Twenty-seven patients with pheochromocytoma complicated with type 2 diabetes who had full follow-up data were enrolled in this study, including 8 males and 19 females, aged (51±9)years old. The postoperative fasting blood glucose was significantly lower than the preoperative one[(5.14±1.37)mmol/L vs. (8.68±5.94)mmol/L, P < 0.01]. The overall remission rate of postoperative diabetes was 78% (21/27) and the non-remission rate was 22%(6/27). Single-variable Logistic regression analysis showed that age, sex, BMI, tumor diameter, and preoperative plasma catecholamine were unrelated to the postoperative remission of diabetes. Conclusions Radical resection for patients with pheochromocytoma complicated with type 2 diabetes could significantly improve diabetes after surgery. Age, sex, BMI, tumor diameter, and preoperative blood catecholamine are not the independent predictive factors for a postoperative remission of diabetes. -
Key words:
- pheochromocytoma /
- type 2 diabetes /
- blood glucose /
- predictive factor
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表 1 27例嗜铬细胞瘤并发2型糖尿病患者基本信息
分组 性别[n(%)] 年龄(x±s, 岁) BMI(x±s, kg/m2) 肿瘤直径(x±s, cm) 术前血浆去甲肾上腺素[M(Q), ng/L] 术前血浆肾上腺素(ng/L) 空腹血糖(x±s, mmol/L) 男 女 术前 术后 缓解组(n=21) 8(38.1) 13(61.9) 50±10 22±4 5.27±2.31 1804 (908, 5544) 182 (49, 635) 8.90±6.70 4.90±1.38* 未缓解组(n=6) 0(0) 6(100) 53±4 23±2 4.17±1.81 1218 (598, 8188) 138 (44, 240) 7.92±1.59 5.97±1.01 P值 0.092 0.511 0.606 0.296 0.457 0.355 0.728 0.090 BMI:体质量指数; 与术前血糖比较, *P＜0.01 
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表 2 单因素Logistic回归分析影响术后糖尿病缓解的预测指标
因素 β值 SE值 Wald值 自由度 P值 OR值 95% CI 年龄 0.034 0.050 0.463 1.000 0.496 1.034 0.939~1.140 性别 -20.430 14 210.361 0.000 1.000 0.999 0.000 - BMI 0.067 0.126 0.284 1.000 0.594 1.070 0.835~1.370 肿瘤直径 -0.274 0.261 1.100 1.000 0.294 0.760 0.455~1.269 血浆去甲肾上腺素 0.000 0.000 0.000 1.000 0.986 1.000 1.000 血浆肾上腺素 -0.002 0.002 0.752 1.000 0.386 0.998 0.994~1.002 BMI:同表 1
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[1] Davison AS, Jones DM, Ruthven S, et al. Clinical evaluation and treatment of phaeochromocytoma[J]. Ann Clin Biochem, 2018, 55: 34-48. doi: 10.1177/0004563217739931 [2] Plouin PF, Amar L, Dekkers OM, et al. European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma[J]. Eur J Endocrinol, 2016, 174: G1-G10. http://smartsearch.nstl.gov.cn/paper_detail.html?id=b8fcdf4bab3878a9528c755a4ab7f49a [3] Fishbein L. Pheochromocytoma and paraganglioma: genetics, diagnosis, and treatment[J]. Hematol Oncol Clin North Am, 2016, 30: 135-150. doi: 10.1016/j.hoc.2015.09.006 [4] Reisch N, Peczkowska M, Januszewicz A, et al. Pheochromocytoma: presentation, diagnosis and treatment[J]. J Hypertens, 2006, 24: 2331-2339. doi: 10.1097/01.hjh.0000251887.01885.54 [5] Douma S, Petidis K, Kartali N, et al. Pheochromocytoma presenting as diabetic ketoacidosis[J]. J Diabetes Complications, 2008, 22: 295-296. doi: 10.1016/j.jdiacomp.2007.02.006 [6] Martin JF, Martin LN, Yugar-Toledo JC, et al. Coronary emergency and diabetes as manifestations of pheochromocytoma[J]. Int J Cardiol, 2010, 139: e39-e41. doi: 10.1016/j.ijcard.2008.11.025 [7] Komada H, Hirota Y, So A, et al. Insulin secretion and insulin sensitivity before and after surgical treatment of pheochromocytoma or paraganglioma[J]. J Clin Endocrinol Metab, 2017, 102: 3400-3405. doi: 10.1210/jc.2017-00357 [8] Chen Y, Hodin RA, Pandolfi C, et al. Hypoglycemia after resection of pheochromocytoma[J]. Surgery, 2014, 156: 1404-1409. doi: 10.1016/j.surg.2014.08.020 [9] La Batide-Alanore A, Chatellier G, Plouin PF. Diabetes as a marker of pheochromocytoma in hypertensive patients[J]. J Hypertens, 2003, 21: 1703-1707. doi: 10.1097/00004872-200309000-00020 [10] Turnbull DM, Johnston DG, Alberti KG, et al. Hormonal and metabolic studies in a patient with a pheochromocytoma[J]. J Clin Endocrinol Metab, 1980, 51: 930-933. doi: 10.1210/jcem-51-4-930 [11] Colwell JA. Inhibition of insulin secretion by catecholamines in pheochromocytoma[J]. Ann Intern Med, 1969, 71: 251-256. doi: 10.7326/0003-4819-71-2-251 [12] Vance JE, Buchanan KD, O'Hara D, et al. Insulin and glucagon responses in subjects with pheochromocytoma: effect of alpha adrenergic blockade[J]. J Clin Endocrinol Metab, 1969, 29: 911-916. doi: 10.1210/jcem-29-7-911 [13] Verberne AJ, Korim WS, Sabetghadam A, et al. Adrenaline: insights into its metabolic roles in hypoglycaemia and diabetes[J]. Br J Pharmacol, 2016, 173: 1425-1437. doi: 10.1111/bph.13458 [14] Mesmar B, Poola-Kella S, Malek R. The physiology behind diabetes mellitus in patients with pheochromocytoma: a review of the literature[J]. Endocr Pract, 2017, 23: 999-1005. doi: 10.4158/EP171914.RA [15] Wiesner TD, Bluher M, Windgassen M, et al. Improvement of insulin sensitivity after adrenalectomy in patients with pheochromocytoma[J]. J Clin Endocrinol Metab, 2003, 88: 3632-3636. doi: 10.1210/jc.2003-030000 [16] Cryer PE. Adrenaline: a physiological metabolic regulatory hormone in humans?[J]. Int J Obes Relat Metab Disord, 1993, 17 Suppl 3: S43-S46; discussion S68. [17] Rizza RA, Cryer PE, Haymond MW, et al. Adrenergic mechanisms for the effects of epinephrine on glucose production and clearance in man[J]. J Clin Invest, 1980, 65: 682-689. doi: 10.1172/JCI109714 [18] Beninato T, Kluijfhout WP, Drake FT, et al. Resection of pheochromocytoma improves diabetes mellitus in the majority of patients[J]. Ann Surg Oncol, 2017, 24: 1208-1213. doi: 10.1245/s10434-016-5701-6 [19] 钟历勇.国际糖尿病联盟第19届世界大会会议纪要及新诊断指南精要解读[J].中国卒中杂志, 2007, 2: 66-67. doi: 10.3969/j.issn.1673-5765.2007.01.017 -
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