上海地区中国人餐后血糖状态的特征  

The features of postprandial glucose state in type 2 diabetes mellitus

作　　者：周健[1] 贾伟平[1] 喻明[1] 马晓静[1] 包玉倩[1] 陆蔚[1] 

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科上海市糖尿病研究所,200233

出　　处：《中华医学杂志》2006年第14期970-975,共6页National Medical Journal of China

基　　金：上海科学技术发展基金资助项目(024032);上海市糖尿病临床医学中心建设基金资助项目(ZX02A13)

摘　　要：目的探讨正常糖调节(NGR)及2型糖尿病(T2DM)个体餐后血糖状态的特征以及T2DM患者餐前、餐后血糖与糖化血红蛋白(HbA1c)的关系。方法采用动态血糖监测系统对上海地区41例NGR及60例新诊断T2DM个体进行连续3d的血糖监测,分析比较餐后血糖峰值与达峰时间,以及餐后血糖漂移的幅度(PPGE)、时间和曲线下面积增值(IAUC)。结果(1)三餐后血糖峰值、达峰时间及PPGE在T2DM组(早餐16·45mmol/L±0·43mmol/L、93·1min±4·7min、6·84mmol/L±0·28mmol/L,中餐14·75mmol/L±0·50mmol/L、107·4min±6·5min、4·93mmol/L±0·31mmol/L,晚餐14·91mmol/L±0·45mmol/L、109·3min±4·9min、5·84mmol/L±0·28mmol/L)显著高于NGR组(早餐6·90mmol/L±0·21mmol/L、40·8min±2·9min、2·02±0·17mmol/L,中餐6·74mmol/L±0·16mmol/L、43·7min±3·1min、2·03±0·12mmol/L,晚餐6·94mmol/L±0·19mmol/L、53·5min±3·8min、2·25mmol/L±0·18mmol/L,均P<0·01)。日内餐后血糖漂移时间及IAUC在T2DM组(14·1h±0·3h,2·04mmol·L-1·d±0·09mmol·L-1·d)亦显著高于NGR组(8·3h±0·4h,0·43mmol·L-1·d±0·03mmol·L-1·d,均P<0·01)。(2)T2DM组早餐后血糖较快达到尖峰(P<0·05),且峰值显著高于中、晚餐(P<0·01),PPGE从高到低的顺序分别为早、晚及中餐(P<0·05),晚餐的IAUC显著高于早、中餐(P<0·01)。(3)HbA1c与IAUC的相关性(r=0·29,P=0·03)在调整餐前血糖的因素后消失(P=0·05);PPGE与IAUC呈显著正相关(r=0·93,P<0·01)。(4)T2DM组餐后血糖对总体日内血糖的贡献百分比显著高于NGR组(18·1%±0·8%比8·0%±0·7%,P<0·01),但均显著低于其餐前血糖(P<0·01)。(5)当HbA1c<7·5%时,餐后血糖升高部分对总体日内高血糖的贡献大于餐前血糖(P<0·05),当HbA1c≥7·5%时,餐前高血糖的相对作用逐渐增加并占主要作用(P<0·01)。结论(1)T2DM患者表现为餐后血糖的过度漂移并持续较长时间,同时伴有血糖尖峰的延迟,其餐后急性高血糖状态以早餐最明显。(2)HbA1c不能反映餐后�Objective To study the features of postprandial glucose state in individuals with normal glucose regulation （NGR） and type 2 diabetes （T2DM） and the relations between hemoglobin Alc （HbAlc） and postprandial glucose in T2DM. Methods 41 NGR individuals and 60 newly diagnosed T2DM patients without previous management in Shanghai were measured by continuous glucose monitoring system for 3 days. The postprandial glucose spike （PGS） , time to PGS （ At）, postprandial glucose excursion （PPGE）, duration of postprandial glucose （DUR） and incremental area under the curve of postprandial glucose （IAUC） were calculated in each individual. Results （ 1 ） The levels of PGS and At in the T2DM group were significantly higher than those of the NGR group （all P 〈0.01 ）. The levels of PPGE, DUR and IAUC of the T2DM group were 5. 87 mmol/L±0. 19 mmol/L, 14. 1 h±0. 3 h and 2. 04 mmol·L^-1·d±0. 09 mmol·L^-1· d respectively, all significantly higher than those of the NGR group （2. 10 mmol/L±0. 12 mmol/L, 8. 3 h±0. 4 h and 0. 43 mmol·L^-1·d ±0. 03 mmol·L^-1·d respectively, all P 〈0. 01 ）. The breakfast had higher PGS and lower At than those of lunch and dinner in the T2DM group （both P 〈 0. 01）. The PPGE was arranged from high to low in the order of breakfast, dinner and lunch. The highest IAUC appeared during dinner. （2） There was a significantly correlation between PPGE and IAUC （ r = 0. 93, P 〈 0. 01 ） in the T2DM group. After being adjusted by preprandial glucose, the partial correlation of HbAlc and IAUC disappeared （ before r = 0. 29, P = 0. 03, after P = 0. 05 ）. （ 3 ） The relative contribution of postprandial glucose to overall glucose levels in the T2DM group was significantly higher than that of the NGR group （18. 1% ±0. 8% vs 8. 0%±0. 7% , P〈0. 01）, but both were significantly lower than those of preprandial glucose. （4） Relative contribution of postprandial hyperglycemia to overall diurnal hyperglycemia decreased progressively fro

关 键 词：糖尿病 非胰岛素依赖型 血糖 血红蛋白A 糖基化 

分 类 号：R181.3[医药卫生—流行病学]