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ADA 2014：低血糖是否增加心血管事件?

2014-06-18 卫生部中日友好医院 赵文惠 中国医学论坛报CMT糖尿病微信

ADA低血糖心血管强化降糖
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强化降糖治疗增加低血糖事件，但是低血糖事件是否增加心血管事件?在ADA 2014上，ORIGIN研究、ACCORD研究和VADT研究的研究者报告了新的循证医学证据。来自瑞典的吕登(Lars E.Ryden)教授报告在ORIGIN研究中，相对于口服降糖药组，甘精胰岛素组低血糖事件更多，包括严重低血糖和非严重低血糖，但是甘精胰岛素组心血管风险却低于口服降糖药组。美国杜克大学法因格罗斯(Mark N.

强化降糖治疗增加低血糖事件，但是低血糖事件是否增加心血管事件?在ADA 2014上，ORIGIN研究、ACCORD研究和VADT研究的研究者报告了新的循证医学证据。

来自瑞典的吕登(Lars E.Ryden)教授报告在ORIGIN研究中，相对于口服降糖药组，甘精胰岛素组低血糖事件更多，包括严重低血糖和非严重低血糖，但是甘精胰岛素组心血管风险却低于口服降糖药组。

美国杜克大学法因格罗斯(Mark N. Feinglos)教授报告的ACCORD研究最新结果显示，虽然强化治疗组死亡率升高，但低血糖并不是罪魁祸首。强化治疗组严重低血糖事件增加，但发生低血糖的人群死亡率却是降低的。VADT研究也得出了相似结果。

低血糖发生时人体交感神经活性增加，血液粘滞性和易栓性增加，可能造成缺血性胸痛、心律失常甚至心肌梗死。但三项研究的结果均提示，虽然强化降糖组的低血糖事件更多，但这种低血糖发生频率较高而严重程度较低，而非强化组的低血糖发生频率较低而严重程度较高，前者造成心血管损害的可能性较低，至少在试验人群中得出了上述结论。

Feinglos教授指出，这种逆向关系(reverserelationship)可能的原因有两点。第一，低血糖发生率高的患者对自己更关注、测血糖频率更高、就诊频率更高。其次，低血糖多次发生，人体分泌肾上腺素减少，机体对肾上腺素的反应下降，这种效果类似缺血预适应。相对于规律发生的轻度低血糖，不规律发生的重度低血糖更危险。

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    2015-04-11 x35042875

    国真实妊娠糖尿病患病率应该在这两种方案得到的患病率之间

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=20758, encodeId=adc720e580f, content=国真实妊娠糖尿病患病率应该在这两种方案得到的患病率之间, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 23:42:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20759, encodeId=453020e59c0, content=国真实妊娠糖尿病患病率应该在这两种方案得到的患病率之间, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 23:42:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643342, encodeId=f805164334229, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Tue May 05 23:34:00 CST 2015, time=2015-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10044, encodeId=d8bd1004487, content=早该有这样的认识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=, createdTime=Tue Jun 24 14:06:00 CST 2014, time=2014-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264514, encodeId=20b71264514e4, content=<a href='/topic/show?id=150f19229c' target=_blank style='color:#2F92EE;'>#ADA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1922, encryptionId=150f19229c, topicName=ADA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Fri Jun 20 01:34:00 CST 2014, time=2014-06-20, status=1, ipAttribution=)]
    2015-04-11 x35042875

    国真实妊娠糖尿病患病率应该在这两种方案得到的患病率之间

    0

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    2015-05-05 hukaixun

    #血管事件#

    0

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    2014-06-24 匿名用户

    早该有这样的认识了

    0

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    2014-06-20 医者仁心

    #ADA#

    0

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