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目的 分析不同病因低血糖症患者的动态血糖谱特点,探讨动态血糖监测系统在低血糖症诊断和鉴别诊断中的应用价值.方法 使用动态血糖监测系统对20例低血糖症患者进行3～6d的动态血糖监测,其中胰岛素瘤6例、反应性低血糖7例、自身免疫性低血糖2例、胰岛细胞增生3例、药物相关性低血糖1例、先天性高胰岛素血症1例.分析不同病因低血糖症患者间的动态血糖谱差异.结果 每例患者平均监测(88.9±10.8)h,在有低血糖的患者中检测出38 ～936次低血糖.各组平均血糖由低到高分别为:先天性高胰岛素血症[(2.97±0.59) rnmol/L]、胰岛细胞增生[(4.83±1.32) mmol/L]、胰岛素瘤[(4.87 ±1.37) mmol/L]、药物性低血糖[(5.98±0.8)mmol/L]、反应性低血糖[(6.38±1.99) mmol/L]、自身免疫性低血糖[(7.63±2.67) mmol/L].低血糖的构成比由低到高分别为:自身免疫性低血糖和药物性低血糖(均为0)、反应性低血糖[0.5％(0,1.6％)]、胰岛素瘤[9.0％(5.2％,16.3％)]、胰岛细胞增生[9.5％(1.1％,14.2％)]、先天性高胰岛素血症(58.5％).分析日夜血糖谱差异,胰岛素瘤[(5.16 ±1.37) mmol/L比(4.44±1.24) mmol/L)]、反应性低血糖[(6.93±2.19) mmol/L比(5.57±1.25) mmol/L)]、自身免疫性低血糖[(8.08 ±2.79) mmol/L比(6.95 ±2.31) mmol/L)]、胰岛细胞增生[(5.23±1.31) mmol/L比(4.11±1.00) mmol/L)]、先天性高胰岛素血症[(3.06±0.57) mmol/L比(2.83±0.59) mmol/L)]均以夜间血糖较低(P均＜0.05);药物性低血糖以日间血糖较低[(5.90±0.81) mmol/L比(6.11±0.77) mmol/L,P＜0.05)].胰岛素瘤和胰岛细胞增生患者分别62.2％和78.9％的低血糖发生在夜间,先天性高胰岛素血症患者43.2％的低血糖发生在夜间.自身免疫性低血糖患者的血糖标准差(2.67 mmol/L)、最大血糖波动幅度(9.2 mmol/L)、变异系数(35.0％)最高.反应性低血糖血糖极差最高(20.4 mmol/L).变异系数(31.6％和22.4％)和血糖极差(20.4 mmol/L和6.8 mmol/L)均在反应性低血糖患者中日夜差异最大.结论 动态血糖监测系统的应用及对平均血糖、血糖谱组成、血糖变异性等参数的分析有助于低血糖症的定性诊断和不同病因的鉴别诊断.“,”Objective To analyze the characteristics of dynamic blood glucose in hypoglycemia patients with different causes and explore the application value of dynamic glucose monitoring system (DGMS) in the diagnosis and differential diagnosis of hypoglycemia.Methods We used DGMS to monitor the blood glucose levels of 20 hypoglycemia patients for 3-6 days,including 6 cases of insulinoma,7 cases of reactive hypoglycemia,2 cases of autoimmune hypoglycemia,3 cases of islet cell hyperplasia,1 case of drug-induced hypoglycemia,1 case of congenital hyperinsulinism.The blood glucose profiles of hypoglycemia patients with different causes were compared.Results The average monitoring duration was (88.9 ± 10.8) hours.38-936 points of hypoglycemia were detected in these patients with hypoglycemia.The average blood glucose of patients of each cause,in the order from low to high,were:congenital hyperinsulinism [(2.97 ± 0.59) mmol/L],islet cell hyperplasia [(4.83 ± 1.32) mmol/L],insulinoma [(4.87 ± 1.37) mmol/L],drug-induced hypoglycemia [(5.98 ±0.8) mmol/L],reactive hypoglycemia [(6.38 ± 1.99) mmol/L],and autoimmune hypoglycemia [(7.63 ± 2.67) mmol/L].The constituent ratio of hypoglycemia from low to high were:autoimmune hypoglycemia and drug-induced hypoglycemia (0％),reactive hypoglycemia [0.5％ (0.0％,1.6％),insulinoma [9.0％ (5.2％,16.3％),islet cell hyperplasia [9.5％ (1.1％,14.2％),congenital hyperinsulinism (58.5％).In terms of the blood glucose profiles in day and night,the night blood glucose levels were lower than those in daytime in insulinoma [(5.16 ± 1.37) mmol/L vs.(4.44 ± 1.24) mmol/L],reactive hypoglycemia [(6.93 ±2.19) mmol/L vs.(5.57 ±1.25) mmol/L],autoimmune hypoglycemia [(8.08 ± 2.79) mmol/L vs.(6.95 ± 2.31) mmol/L],islet cell hyperplasia [(5.23 ± 1.31) mmol/L vs.(4.11 ± 1.00) mmol/L] and congenital hyperinsulinism [(3.06 ±0.57) mmol/L vs.(2.83 ±0.59) mmol/L] (all P ＜ 0.05);while the daytime blood glucose level was lower than that at night in drug-induced hypoglycemia [(5.90 ±0.81) mmol/L vs.(6.11 ±0.77) mmol/L,P ＜0.05].62.2％ and 78.9％ of the hypoglycemia episodes happened at night in patients with insulinoma and islet cell hyperplasia,and 43.2％ at night in patients with congenital hyperinsulinism.The highest standard deviation of blood glucose (2.67 mmol/L),largest amplitude of glycemic excursions (9.2 mmol/L) and coefficient of variation (35％) were found in patients with autoimmune hypoglycemia.The largest range of blood glucose (20.4 mmol/L) was found in patients with reactive hypoglycemia.The day-night differences in coefficient of variation (31.6％ vs.22.4％) and range of blood glucose (20.4 mmol/L vs.6.8 mmol/L) were most prominent in patients with reactive hypoglycemia.Conclusion The dynamic monitoring of blood glucose and the analysis of the parameters such as average blood glucose,blood glucose profiles and variability of blood glucose may be helpful for the diagnosis of hypoglycemia and differential diagnosis of causes of hypoglycemia.