2型糖尿病合并冠心病患者血糖变化与内皮功能的相关性  

Correlation of changes of glucose fluctuation with endothelium-dependent flow-mediated dilation in type 2 diabetic patients with coronary heart disease

作　　者：赵大坤[1] 吕肖锋[1] 程千鹏[1] 高宇[1] 周淑香[1] 

机构地区：[1]北京军区总医院,北京100700

出　　处：《中国热带医学》2012年第5期600-603,共4页China Tropical Medicine

摘　　要：目的探讨2型糖尿病合并冠心病患者血糖波动的变化及对其肱动脉内皮依赖性舒张功能(FMD)的影响。方法选取近期经冠脉造影术确诊为冠心病的2型糖尿病患者30例为T2DM1组作为主要研究对象,同时选取病程、糖化血红蛋白等一般临床资料匹配的经冠脉造影术排除冠心病的2型糖尿病患者20例为T2DM2组,所有对象接受FMD检测及动态血糖监测系统(CGMS)监测。比较T2DM1组血糖波动的变化,并分析其与FMD的相关性。结果 (1)与T2DM2组相比,T2DM1组的日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、平均餐后血糖波动幅度(MPPGE)、低血糖曲线下面积(IAUC70)明显升高,差异有统计学意义(P<0.05)。(2)对T2DM1组FMD进行分析显示,FMD与MAGE、MODD、PPGE、IAUC70等血糖波动系数明显相关(P<0.05),其中与MAGE相关性最强;以FMD为因变量,各相关因素为自变量行多元逐步回归分析显示,调整其他影响因素后,MAGE仍与FMD呈负相关,且MAGE、IAUC70、收缩压均是影响FMD的独立因素。结论 2型糖尿病合并冠心病患者血糖波动较不合并冠心病患者明显增加,FMD明显受损,血糖波动与FMD受损具有相关性。Objective To explore the changes of glycemic fluctuation in diabetic patients with coronary heart disease and the effects of glycemic fluctuation on endothelia-dependent flow-mediated dilation.Methods The type 2 diabetes diagnosed with coronary heart disease by coronary angiography detection recently were chosen to be the main study subjects of group-T2DM1,thene T2DM-patients who were matching with subjects of group T2DM1 in duration of type 2 diabetes mellitus and HbA1c without CHD（be exclusive CHD by coronary angiography detection）were chosen as subjects of group-T2DM2.All research subjects accepted high frequency ultrasound detection on arteriae brachialis for FMD and a continuous glucose monitoring system（CGMS） detection for glycemic excursion.Results Compared with group-T2DM2,there were significantly higher levels of mean amplitude of glycemic excursions（MAGE）,absolute means of daily differences（MODD）,mean postprandial glucose excursion（MPPGE）,and incremental area under the curve（IAUC70） below 70mg/dl（3.9 mmol/L） in group T2DM1（P〈0.05）;Analysis on FMD of group T2DM1 indicates that MAGE,MODD,MPPGE,IAUC70 were remarkblely correlated with FMD and MAGE was the most relevant one;as FMD taken as the dependent variable and the various relative factors as the independent variables,multiple stepwise regression analysis showed that MAGE was still negatively correlated with FMD after adjusting the other factors and MAGE,IAUC70,SBP were the independent impact factors of FMD in diabetic patients with coronary heart disease.Conclusions Glycemic fluctuation is increased and FMD is impaired apparently in diabetic patients with coronary heart disease,glycemic fluctuation is related to the impairment of FMD.

关 键 词：2型糖尿病 冠心病 血糖波动 动态血糖监测 血管内皮依赖性舒张功能 

分 类 号：R587.1[医药卫生—内分泌]