持续糖监测系统在兔低血糖模型中的应用评估
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Evaluation of the value of application of continuous glucose monitoring system in a rabbit model of hypoglycemia
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    摘要:

    目的 建立兔低血糖模型,并评估皮下持续糖监测系统(CGMS)在低血糖监测时的准确性和及时性。方法 选用雌性新西兰大耳白兔16只,随机分为4组,每组4只。对照组为持续静脉注射生理盐水,实验组动物持续静脉注射胰岛素,根据剂量不同分为胰岛素0.1 U/(kg·h)组(RI=0.1 U组)、胰岛素0.2 U/(kg·h)组(RI=0.2 U组)和胰岛素0.4 U/(kg·h)组(RI=0.4 U组)。试验期间实施监测CGMS 240 min,间隔30 min采集耳缘静脉血,由手持血糖测定仪监测血糖(BG监测值)。结果 研究期间共获得CGMS监测数据1296个,与CGMS时间匹配的BG监测数据136个。应用胰岛素后BG和CGMS均明显降低, RI=0.1U组BG和CGMS降低速度分别为每分钟0.016和0.017 mmol/L; RI=0.2U组分别为每分钟0.04和0.027 mmol/L;RI=0.4 U组分别为每分钟0.049和0.032 mmol/L。按照BG监测值是否低于4.4 mmol/L将BG-CGMS配对数据分为低血糖和正常血糖两类。低血糖时BG-CGMS的平均偏差为0.55 mmol/L(上下限:-0.98~2.08 mmol/L),绝对差值百分率(RAD)为40.2%±45.2%;正常血糖时的BG-CGMS平均偏差为-0.19 mmol/L(上下限:-1.38~1.00 mmol/L),RAD为5.8%±5.3%。误差栅格分析(EGA)显示A区占比为93.4%,B区为0.7%,D区为5.9%,且D区均分布于BG低CGMS高的区域。结论 本研究结果提示,当血糖降低速度增快时,CGMS出现明显的滞后现象,当血糖降低至4.4 mmol/L以下时,CGMS存在高估血糖的危险。CGMS临床应用时应充分考虑这种危险。

    Abstract:

    Objective To establish a rabbit model of hypoglycemia and evaluate the accuracy and timeliness of hypoglycemia monitoring by continuous glucose monitoring system (CGMS). Methods Sixteen female New Zealand white rabbits were randomly divided into 4 groups, with 4 rabbits in each group. The rabbits in the control group were given intravenous infusion of saline. The animals in the experimental group were infused with insulin continuously, which were divided into 0.1 U/kg/h insulin group (RI=0.1 U group), 0.2 U/kg/h insulin (RI=0.2 U group) group and 0.4 U/kg/h insulin group (RI=0.4 U group) accordingly. During the experiment, CGMS was monitored for 240 min. Blood samples were collected at a 30-minute interval and the blood glucose level was measured by a hand glucose meter. Results A total of 1296 CGMS monitoring data were obtained during the study period, and 136 BG monitoring data matched with CGMS time were obtained. After the insulin administration, BG and CGMS were significantly decreased. The reduction rates of BG and CGMS were 0.016 and 0.017 mmol/L/min in the RI=0.1 U insulin group, 0.04 and 0.027 mmol/L/min in the RI=0.2U insulin group, and 0.049 and 0.032 mmol/L/min in the RI=0.4 U group. According to whether BG monitoring value was lower than 4.4 mmol/L, the BG-CGMS paring data were divided into hypoglycemia and normoglycemia. In hypoglycemia, the average deviation of BG-CGMS was 0.55 mmol/L (the upper and lower limits were -0.98 and 2.08 mmol/L, respectively) and the absolute difference percentage (RAD) was 40.2% ±45.2%. The mean deviation of BG-CGMS in normal blood glucose was -0.19 mmol/L (upper and lower limits were -1.38 and 1.00 mmol/L, respectively) and 5.8% ±5.3% in RAD. The error grid analysis (EGA) showed that the proportion of zone A was 93.4%, 0.7% in zone B, and 5.9% in zone D, and the zone D was distributed in area of low BG and high CGMS. Conclusions The results of this study indicate that CGMS has a significant hysteresis phenomenon when blood glucose is reduced rapidly. When the blood glucose levels fall below 4.4 mmol/L, CGMS may have a risk of overestimating blood glucose. Such risk should be fully considered during CGMS clinical application.

    参考文献
    [1] Sato J, Kanazawa A, Ikeda F, et al. Effect of treatment guidance using a retrospective continuous glucose monitoring system on glycaemic control in outpatients with type 2 diabetes mellitus:A randomized controlled trial[J]. J Int Med Res, 2016, 44(1):109-121.
    [2] Ma Z, Chen R, Liu Y, et al. Effect of liraglutide vs. NPH in combination with metformin on blood glucose fluctuations assessed using continuous glucose monitoring in patients with newly diagnosed type 2 diabetes[J]. Int J Clin Pharmacol Ther, 2015, 53(11):933-939.
    [3] Lane JE, Shivers JP, Zisser H. Continuous glucose monitors:current status and future developments[J]. Curr Opin Endocrinol Diabetes Obes 2013, 20:106-111.
    [4] Yue XY, Zheng Y, Cai YH, et al. Real-time continuous glucose monitoring shows high accuracy within 6 hours after sensor calibration:a prospective study[J]. Plos One 2013, 8:e60070.
    [5] 史春虹,季阳阳,白然,等. 实时动态胰岛素泵与"双C"方案对血糖控制不佳的2型糖尿病患者的疗效对比[J]. 中华医学杂志, 2015, 95(24):1930-1933.
    [6] Dell'Aquila AM, Ellger B. Perioperative glycemic control:what is worth the effort? Curr Opin Anaesthesiol, 2013, 26:438-443.
    [7] Yeoh E, Choudhary P, Nwokolo M, et al. Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes:A systematic review and meta-analysis[J]. Diabetes Care, 2015, 38(8):1592-1609.
    [8] 宋依临,杨慧霞. 动态血糖监测和自我血糖监测在妊娠合并糖尿病患者血糖监测中的临床价值[J]. 中华妇产科杂志, 2014, 49(8):579-583.
    [9] Brunner R, Kitzberger R, Miehsler W, et al. Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in critically ill patients[J]. Crit Care Med, 2011, 39:659-664.
    [10] Gomez A M, Marin S A, Munoz O M, et al. Numerical and clinical precision of continuous glucose monitoring in Colombian patients treated with insulin infusion pump with automated suspension in hypoglycemia[J]. Endocrinol Nutr, 2015, 62(10):485-492.
    [11] Jacobs B, Phan K, Bertheau L, et al. Continuous glucose monitoring system in a rural intensive care unit:a pilot study evaluating accuracy and acceptance[J]. J Diabetes Sci Technol 2010, 4:636-644.
    [12] Lee JH, Kim K, Jo YH, et al. Feasibility of continuous glucose monitoring in critically ill emergency department patients[J]. J Emerg Med, 2012, 43:251-257.
    [13] Johnson KW, Mastrototaro JJ, Howey DC, et al. In vivo evaluation of an electroenzymatic glucose sensor implanted in subcutaneous tissue[J]. Biosens Bioelectron, 1992, 7:709-714.
    [14] Mori A, Kurishima M, Oda H, et al. Comparison of glucose fluctuations between day-and night-time measured using a continuous glucose monitoring system in diabetic dogs[J]. J Vet Med Sci, 2013, 75:113-117.
    [15] Holzinger U, Miehsler W, Warszawska J, et al. Real-time continuous glucose monitoring in critically ill patients. A prospective randomized trial[J]. Diabetes Care, 2010, 33:467-472.
    [16] 王辰,朱宇清,帅学军. 实时动态血糖监测系统在危重症胰岛素强化治疗中作用的荟萃分析[J]. 中华急诊医学杂志, 2015, 24(3):320-324.
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郑一,王楠.持续糖监测系统在兔低血糖模型中的应用评估[J].中国比较医学杂志,2017,27(3):68~74.

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