摘要
恶性肿瘤和糖尿病均已逐渐成为中国常见的慢性非传染性疾病,两者关系密切,糖尿病患者中多种恶性肿瘤的发生风险增加、致死率高、预后不良,肿瘤患者中血糖升高很常见。部分恶性肿瘤可导致高血糖和(或)糖尿病,恶性肿瘤的治疗(包括手术应激、化疗药物、放射治疗、糖皮质激素、多种靶向药物、免疫检查点抑制剂的应用等)过程中可能出现高血糖和(或)糖尿病,统称为肿瘤相关性高血糖。肿瘤相关性高血糖在临床上管理难度大,血糖控制情况的好坏与恶性肿瘤患病风险及不良预后密切相关,目前尚无相关的指南可用于指导临床诊治和管理。因此,恶性肿瘤相关性高血糖的规范化管理问题日益受到内分泌科及肿瘤科专家的重视,临床上也迫切需要就肿瘤相关性高血糖的管理进行规范化的指导。有鉴于此,中国抗癌协会肿瘤内分泌专业委员会和重庆市中西医结合学会肿瘤内分泌分会综合国内肿瘤学和内分泌学多位专家的意见起草了《肿瘤相关性高血糖管理指南(2021年版)》。该指南除归纳和总结糖尿病与多种恶性肿瘤的关系,肿瘤导致高血糖和(或)糖尿病的病因,肿瘤相关性高血糖的流行病学,肿瘤相关性高血糖的概念,诊断和鉴别诊断标准外,还重点介绍了肿瘤相关性高血糖的规范化管理,包括肿瘤相关性高血糖的总体评估方法和原则,个体化控制目标,住院期间的管理(入院前准备,住院期间患者的血糖管理措施,胰岛素疗法,重症监护病房和非重症监护病房的管理,酮症酸中毒和高渗性高血糖状态,低血糖的处理,围手术期血糖管理,非进食肠内或肠外营养情况下血糖的管理,妊娠合并高血糖或糖尿病的管理,糖皮质激素的应用的管理,临终关怀,从住院到门诊的过渡,用药注意事项,出院前处理等情况),多种降糖药物对恶性肿瘤的影响,肿瘤治疗药物对血糖的影响和门诊期间的管理,包括恶性肿瘤患者档案的建立,血糖及并发症相关问题的健康检查,长期的随访和评估。此外,结合中国医疗的实际情况,指南针对肿瘤相关性高血糖患者的双向转诊和分级诊疗提出了相关建议和标准,以利于各层级医疗机构和医务人员方便的执行。本指南对推荐意见根据循证医学证据等级分级原则提出了相应的分级,将有助于临床医师对肿瘤相关性高血糖患者进行合理化和规范化的管理,以期改善其临床结局和预后。现就该指南的内容和推荐意见做一解读。
Malignant tumors and diabetes mellitus have gradually become the most common chronic non-communicable diseases in China.They are closely related.The risk,mortality and adverse prognosis of various malignant tumors in diabetic patients are significantly increased.Hyperglycemia in cancer patients is very common.From the aspect of etiology,some malignant tumors lead to hyperglycemia and/or diabetes,and hyperglycemia and/or diabetes can occur during the treatment of malignant tumors,including surgical stress,chemotherapeutic drugs,radiotherapy,glucocorticoids,a variety of targeted drugs and the application of immune checkpoint inhibitors,which is collectively referred to as tumor-associated hyperglycemia.Tumor-associated hyperglycemia is difficult to manage in clinical practice,and the quality of blood glucose control is closely related to the risk and adverse prognosis of patients with malignant tumor.However,there is currently no relevant guideline for the clinical diagnosis and management.Therefore,standardized management of malignant tumor-associated hyperglycemia is necessary.In view of this,the Onco-endocrinology Society of Chinese Anti-Cancer Association and Onco-endocrinology Society of Chong Qing Integrative Medicine Association have drafted Guidelines for the Management of Tumor-associated Hyperglycemia(2021 Edition),a comprehensive report based on the opinions of many domestic experts in oncology and endocrinology.In addition to summarizing the relationship between diabetes and multiple malignant tumors,the guidelines include the etiology of tumor-associated hyperglycemia/diabetes,the epidemiology of tumor-associated hyperglycemia,the concept of tumor-associated hyperglycemia,the diagnostic and differential diagnostic criteria and the standardized management of tumor-associated hyperglycemia,including the overall assessment methods and principles of tumor-associated hyperglycemia,individualized control objectives,management during clinical hospitalization(preadmission preparation,blood glucose management during hospitalization,insulin therapy,intensive care unit and non-intensive care unit management,ketoacidosis and hyperosmolar hyperglycemia,hypoglycemia treatment,perioperative blood glucose management,blood glucose management during enteral/parenteral nutrition,pregnancy with hyperglycemia or diabetes management,glucocorticoid application management,hospice care,transition from inpatient to outpatient,medication precautions,predischarge treatment,etc.),the impact of a variety of hypoglycemic drugs on malignant tumors,the impact of tumor therapeutic drugs on blood glucose and outpatient management,including the establishment of archives of patients with malignant tumors,health examination of blood glucose and complications,long-term follow-up and evaluation.In addition,combined with the actual medical situation in China,the guidelines provide two-way referral and graded diagnosis and treatment for patients with tumor-associated hyperglycemia and put forward relevant suggestions and standards to facilitate the convenient implementation of medical institutions and medical personnel at all levels.The guidelines put forward the corresponding classification of recommendations according to the principle of evidence-based medical evidence classification,which will help clinicians to rationalize and standardize the management of patients with tumor-associated hyperglycemia,so as to improve their clinical outcome and prognosis.Here,we made an interpretation of the contents and recommendations.
作者
吴绮楠
童南伟
WU Qinan;TONG Nanwei(Department of Endocrinology,Dazu Hospital of Chongqing Medical University,The People's Hospital of Dazu,Chongqing 400030,China;Department of Endocrinology and Metabolism,West China Hospital of Sichuan University,Chengdu 610000,Sichuan Province,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2021年第12期1153-1161,共9页
China Oncology
基金
国家科技部重大专项(2016YFC1303702)
重庆市科技局与卫健委联合中医药技术创新与应用发展资助项目(2020ZY013540)。
关键词
肿瘤相关性高血糖
管理
指南解读
Tumor-associated hyperglycemia
Management
Interpretation of guidelines
