球后注射曲安奈德治疗黄斑水肿对老年患者血糖水平的影响

Effect of retrobular injection of triamcinolone acetonide on blood glucose in elderly patients with macular edema

摘要:

目的 糖皮质激素是所有药物中对血糖影响最大的药物,观察球后注射曲安奈德治疗老年人糖尿病性及非糖尿病性黄斑水肿(DME)对血糖的影响。方法 选取北京老年医院眼科≥65岁DME患者80例,分为糖尿病组和非糖尿病组,每组40例,40只眼,给予患眼球后注射曲安奈德20 mg治疗。监测患者给药前、治疗后连续7 d及治疗后14 d的空腹血糖和餐后2小时血糖。采用SPSS 17.0统计软件进行分析。组内比较采用方差分析,组间比较采用独立样本t检验。结果 非糖尿病组患者的空腹血糖[(5.35±0.33)mmol/L]、餐后2小时血糖[(7.66±0.34)mmol/L]及糖尿病组患者的空腹血糖[(8.53±0.59)mmol/L]在第2天升为最高,糖尿病组患者的餐后2小时血糖[(13.32±2.70)mmol/L]在第3天升至最高。非糖尿病组在治疗后第4、5、6、7及14天的血糖水平和治疗前比较,差异无统计学意义,而糖尿病组在注射的第14天血糖升高相比治疗前,差异仍有统计学意义(P<0.05)。糖尿病组较非糖尿病组的空腹血糖最大差值[(0.65±0.21) vs (2.91±0.27)mmol/L ]和餐后2小时血糖最大差值[(1.10±0.37) vs (4.59±2.15)mmol/L]均显著增加(P<0.01)。结论球后注射曲安奈德可引起血糖升高,升高峰值出现在注射后第2天或第3天,且对糖尿病患者影响更明显。眼科医师应对此类药物的副作用给予关注。

Abstract:

Objective To determine the effect of retrobular injection of triamcinolone acetonide on blood glucose in the elderly patients with diabetic and non-diabetic macular edema (ME). Methods A total of 80 elderly patients (over 65 years old)with diabetic and non-diabetic ME admitted in Ophthalmological Department of our hospital from December 2015 to November 2016 were enrolled in this study. They were divided into diabetic and non-diabetic groups, with 40 cases(40 eyes) in each group, and underwent retrobulbar injection of 20 mg triamcinolone acetonide.Fasting plasma glucose(FPG) and 2-hour postprandial blood glucose (2hPBG) were mea-sured on the day of treatment (before treatment), on continuous 7 days and in 14 d(2 weeks) after treatment. SPSS statistics 17.0 was used to perform the statistical analysis. Analysis of variance was employed for the intra-group comparison, and independent sample t test for comparison between groups. Results The FPG [(5.35±0.33)mmol/L] and 2hPBG [(7.66±0.34)mmol/L] levels reached the highest values on day 2 in the non-diabetic group, but for the diabetic group, the peak values were observed on day 2 [(8.53±0.59)mmol/L]and day 3 [(13.32±2.70)mmol/L]respectively, with statistical significances in the time points. There were no differences in blood glucose level in the non-diabetic group on days 4,5,6,7 and 14 with that before treatment. But, the level was obviously increased in the diabetic group even on day 14 when compared with that before treatment. What’s more, the maximum difference of FPG [(0.65±0.21) vs (2.91±0.27)mmol/L] and 2hPGB [(1.10±0.37) vs (4.59±2.15)mmol/L] were more significantly increased in the diabetic group than in the non-diabetic group (P<0.01). Conclusion Retrobular injection of triamcinolone acetonide results in increased blood glucose, with the peak on day 2 or 3 after injection, and the effect is more significant for diabetic patients. Ophthalmologists should pay great attention on systemic side effects of such drugs.