摘要目的:调查分析2型糖尿病（T2DM）患者低血糖感知受损（IAH）的现状，并探讨不同评估方法下IAH的影响因素。方法:采用便利抽样的方法，选择2023年6至12月在华中科技大学同济医学院附属同济医院内分泌科住院的352例T2DM患者作为研究对象。使用一般资料调查表收集一般资料，采用Gold评分、Clarke问卷、Pedersen问卷评估IAH。采用Spearman相关分析法分析3个IAH评估量表结果之间的相关性，采用二元logistic回归分析法分析IAH的影响因素。根据病程、年龄、胰岛素使用情况等基线特征，对患者进行分层，并采用Kruskal-Wallis H检验分析不同评估工具的差异。 结果:采用Gold评分、Clarke问卷、Pedersen问卷3种评估工具评估T2DM患者IAH的发生率分别为33.0%（116/352）、24.1%（85/352）、41.5%（146/352）。Gold评分与Clarke问卷、Pedersen问卷得分有相关性（ r=0.485， P<0.001； r=0.571， P<0.001），Clarke问卷与Pedersen问卷得分有相关性（ r=0.699， P<0.001）。二元logistic回归分析结果显示，采用Gold评分评估时，胰岛素使用时间（OR=1.05，95%CI 1.01~1.10）、低血糖恐惧水平（OR=1.04，95%CI 1.01~1.07）、独居状态（OR=4.04，95%CI 1.27~12.90）和每年低血糖发生次数≥5次（OR=1.39，95%CI 1.17~2.88）是IAH发生的影响因素。采用Clarke问卷评估时，胰岛素使用时间较长和低血糖恐惧程度较高同样与IAH风险增加相关，其OR值（95%CI）分别为1.07（1.02~1.13）和1.06（1.03~1.09）。并且，糖尿病并发症个数为1时，似乎能降低IAH的发生风险（OR=0.32，95%CI 0.11~0.94）。采用Pedersen问卷评估时，胰岛素使用时间（OR=1.07，95%CI 1.02~1.11）和低血糖恐惧（OR=1.07，95%CI 1.04~1.10）的增加与IAH风险的增加有关。特定亚组分析中，仅Gold评分在病程和胰岛素使用情况方面差异有统计学意义（ H=12.42， P=0.002； Z=-3.64， P<0.001）。 结论:T2DM患者IAH受多种因素影响，3种评估工具虽有差异但一致性良好，尤其在病程长和使用胰岛素的患者群体中，Gold评分具有一定优势。

abstractsObjective:To investigate the prevalence of impaired awareness of hypoglycemia (IAH) in patients with type 2 diabetes mellitus (T2DM) and to explore the factors influencing IAH using different assessment methods.Methods:From June to December 2023, a convenience sampling method was used to select 352 patients with T2DM from Department of Endocrinology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology. Tools such as general information questionnaires, Gold score, Clarke questionnaire, and Pedersen questionnaire were used for assessment. Influencing factors were screened by univariate and correlation analyses, followed by binary logistic regression analysis to identify independent factors of IAH. Patients were stratified according to baseline characteristics such as disease duration, age, and insulin use, and differences between assessment tools were evaluated using the Kruskal-Wallis H test. Results:The incidence of IAH was 33.0% (116/352), 24.1% (85/352), and 41.5% (146/352) in T2DM patients assessed according to Gold score, Clarke questionnaire and Pedersen questionnaire, respectively, with different results. Gold scores were highly correlated with both Clarke questionnaire and Pedersen questionnaire scores ( r=0.485, P<0.001; r=0.571, P<0.001), and Clarke scores were highly correlated with Pedersen scores ( r=0.699, P<0.001).The results of binary logistic regression analysis showed that, using the Gold score as an example, duration of insulin use (OR=1.05, 95%CI 1.01-1.10), level of hypoglycemia fear (OR=1.04, 95%CI 1.01-1.07), living alone (OR=4.04, 95%CI 1.27-12.90) and hypoglycemia occurring more than 5 times per year (OR=1.39, 95%CI 1.17-2.88) were the influencing factors of IAH. Duration of insulin use and higher levels of hypoglycaemia fear were also associated with an increased risk of IAH when assessed using the Clarke questionnaire, with their OR value (95%CI) of 1.07 (1.02-1.13) and 1.06 (1.03-1.09) respectively. However, when the number of diabetic complications was 1, it appeared to reduce the risk of IAH (OR=0.32, 95%CI 0.11-0.94). When assessed with the Pedersen questionnaire, increased duration of insulin use (OR=1.07, 95%CI 1.02-1.11) and hypoglycaemia fear (OR=1.07, 95%CI 1.04-1.10) were associated with an increased risk of IAH. In subgroup-specific analyses, only the Gold score showed significant differences in duration of diseases and insulin use ( H=12.42, P=0.002; Z=-3.64, P<0.001). Conclusions:IAH in patients with T2DM is influenced by many factors. Although there are differences among the three assessment tools, they show good consistency, especially in patients with long duration of disease and insulin use, where the Gold score has certain advantages.