生玉米淀粉对胰岛素瘤导致的低血糖症的疗效：一种前景看好的辅助疗法

Q2 Medicine

Chinese Medical Sciences Journal Pub Date : 2024-06-01 DOI:10.24920/004329

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引用次数: 0

摘要

目的探讨生玉米淀粉（RCS）在胰岛素瘤所致低血糖临床治疗中的疗效。方法回顾性收集术前接受RCS辅助饮食的胰岛素瘤患者的临床资料，分析RCS干预对血糖控制、体重变化及其不良反应的治疗效果。补充 RCS 饮食前，所有患者均频繁发生低血糖（2.51 ± 3.88 次/周），同时伴有神经性糖耐量减低症（83.3% 的患者）和自主神经表现（75.0% 的患者），空腹血糖（FBG）中位数为 2.70 [四分位数间距（IQR）：2.50-2.90] mmol/L。患者体重每月增加 0.38（IQR：0.05-0.65）千克，其中 8 例（33.3%）发展为超重，7 例（29.2%）发展为肥胖。所有患者在接受肿瘤切除术（23 例）和经动脉化疗栓塞治疗肝转移瘤（1 例）之前，一直保持补充 RCS 的饮食习惯。19 名全天接受 RCS 的患者在营养管理一周内的 FBG 中位数为 4.30（IQR：3.30-5.70）mmol/L，与营养前水平 [2.25 （IQR：1.60-2.90）mmol/L；P = 0.000]相比显著增加。其中，10 名患者全天接受 RCS 超过四周，与治疗前相比，FBG 有持续改善 [3.20 (IQR: 2.60-3.95) mmol/L vs. 2.15 (IQR: 1.83-2.33) mmol/L；P = 0.000]。五名仅在夜间接受 RCS 的患者的 FBG 也在营养管理一周内显著增加 [3.50 (IQR: 2.50-3.65) mmol/L vs. 2.20 (IQR:1.80-2.60) mmol/L；P = 0.000]，但只有一名持续接受 RCS 超过 4 周的患者的 FBG 没有显著改善。补充 RCS 后体重增加没有改善。出现轻度腹泻（2 例）和胀气（1 例），减少 RCS 剂量后症状缓解。

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Efficacy of Raw Corn Starch in Insulinoma-Related Hypoglycemia: A Promising Supportive Therapy

Objective

To investigate the efficacy of raw corn starch (RCS) in clinical management of insulinoma-induced hypoglycemia.

Methods

We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively, and analyzed the therapeutic effects of the RCS intervention on blood glucose control, weight change, and its adverse events.

Results

The study population consisted of 24 cases of insulinoma patients, 7 males and 17 females, aged 46.08±14.15 years. Before RCS-supplemented diet, all patients had frequent hypoglycemic episodes (2.51±3.88 times/week), concurrent with neuroglycopenia (in 83.3% of patients) and autonomic manifestations (in 75.0% of patients), with the median fasting blood glucose (FBG) of 2.70 (interquartile range [IQR]: 2.50–2.90) mmol/L. The patients' weight increased by 0.38 (IQR: 0.05 – 0.65) kg per month, with 8 (33.3%) cases developing overweight and 7 (29.2%) cases developing obesity. All patients maintained the RCS-supplemented diet until they underwent tumor resection (23 cases) and transarterial chemoembolization for liver metastases (1 case). For 19 patients receiving RCS throughout the day, the median FBG within one week of nutritional management was 4.30 (IQR: 3.30–5.70) mmol/L, which was a significant increase compared to pre-nutritional level [2.25 (IQR: 1.60–2.90) mmol/L; P < 0.001]. Of them, 10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment [3.20 (IQR: 2.60–3.95) mmol/L vs. 2.15 (IQR: 1.83 – 2.33) mmol/L; P < 0.001). Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management [3.50 (IQR: 2.50–3.65) mmol/L vs. 2.20 (IQR: 1.80–2.60) mmol/L; P < 0.001], but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG. No improvement in weight gain was observed upon RCS supplementation. Mild diarrhea (2 cases) and flatulence (1 case) occurred, and were relieved by reduction of RCS dose.