血糖波动对初诊2型糖尿病患者血管内皮功能及C-反应蛋白的影响研究  

Influence of Glucose Fluctuation on Endothelial Function and C-Reactive Protein in Newly Diagnosed Type 2 Diabetics

作　　者：赵大坤[1,2] 吕肖锋[1] 高宇[3] 周淑晶[1] 杜健[1] 武晋晓[1] 

机构地区：[1]安徽医科大学附属北京军区总医院临床学院内分泌科,北京市100700 [2]安徽医科大学 [3]安徽医科大学附属北京军区总医院临床学院超声科

出　　处：《中国全科医学》2012年第13期1475-1478,共4页Chinese General Practice

摘　　要：目的探讨血糖波动对初诊2型糖尿病(T2DM)患者肱动脉内皮依赖性舒张功能(FMD)及血清C-反应蛋白(CRP)的影响。方法在糖化血红蛋白(HbA1c)≤8.0%的初诊T2DM患者中行动态血糖监测,据监测结果选取30例3倍血糖标准差(SD)<平均血糖(MBG)的患者为血糖波动小组(A组),30例3倍SD≥MBG的患者为血糖波动大组(B组)。两组患者均接受FMD检查及CRP测定,比较两组间FMD、CRP的差异,探讨血糖波动对两者的影响。结果 (1)与A组相比,B组的CRP及日内平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、平均餐后血糖波动幅度(MPPGE)、日间血糖平均绝对差(MODD)明显升高,FMD明显下降,差异均有统计学意义(P<0.05)。(2)分别以FMD、CRP为因变量,各相关因素为自变量行多元逐步回归分析,结果显示MAGE、收缩压(SBP)是影响FMD的独立因素;LAGE、胰岛素抵抗指数(HOMA-IR)、MPPGE是影响CRP的独立因素。(3)简单相关显示,FMD与CRP显著相关(P<0.05)。结论血糖波动可能参与了初诊T2DM患者内皮功能及炎性状态的改变,并可通过增强体内炎性状态增加对内皮功能的损害。Objective To explore the influence of glucose fluctuation on endothelium-dependent flow-mediated dilation（FMD） and plasma C-reactive protein（CRP） in newly diagnosed patients with type 2 diabetes mellitus（T2DM）. Methods T2DM patients with glycosylated hemoglobin（HbA1c）≤8.0% accepted a continuous glucose monitoring system（CGMS） detection.According to the results of CGMS,30 patients whose 3 times of standard deviation of blood glucose（SD）diurnal mean blood glucose（MBG） were chosen as low glucose excursion group（group A）,and 30 patients whose 3 times of SD≥MBG were chosen as high glucose excursion group（group B）.All patients accepted high frequency ultrasound detection on brachial arteries for FMD and a CRP test.Then the influence of glucose fluctuation on FMD and CRP was explored through comparison of the results between the two groups. Results（1） Compared with group A,the level of CRP,mean amplitude of glycemic excursions（MAGE）,largest amplitude of glycemic excursions（LAGE）,mean postprandial glucose excursion（MPPGE）,and absolute means of daily differences（MODD） were significantly increased;while the level of FMD was significantly decreased in group B（P0.05）.（2） As FMD,CRP were taken as the dependent variable respectively,and the various relative factors as the independent variables,multiple stepwise regression analysis showed that MAGE and systolic blood pressure were the independent impact factors of FMD;LAGE,HOMA-IR,and MPPGE were the independent impact factors of CRP.（3） The Pearson correlation analysis indicated that FMD and CRP were remarkably correlated（P0.05）. Conclusion Glycemic fluctuation might directly contribute to the change of endothelial function and inflammatory state in newly diagnosed T2DM patients,and increase the impairment of endothelial function through the enhancement of in vivo inflammatory state.

关 键 词：糖尿病 2型 血糖波动 动态血糖监测 内皮功能 C-反应蛋白 

分 类 号：R587.1[医药卫生—内分泌]