2型糖尿病患者颈动脉内膜中层厚度与血糖波动的相关性研究  

Correlation between carotid intima-media thickness and glucose fluctuation in type 2 diabetic patients

作　　者：黄金鑫[1] 吕肖锋[1] 洛佩[1] 张星光[1] 焦秀敏[1] 赵大坤[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,北京100700

出　　处：《中华全科医师杂志》2013年第4期268-271,共4页Chinese Journal of General Practitioners

摘　　要：目的探讨2型糖尿病患者颈动脉内膜中层厚度（CIMT）与血糖波动的相关性。方法将我院2012年3至8月收治的68例2型糖尿病患者，根据颈动脉超声结果分为两组，CIMT增厚组36例（CIMT≥0．9mm）和CIMT正常组32例（CIMT〈0．9mm），在入院当天行72h动态血糖监测，并检测相关生化指标。结果①两组间性别、年龄、BMI、血压、HDL—C、LDL—C、TC、TG、糖化血红蛋白、空腹血糖、餐后2h平均血糖比较，差异均无统计学意义（P〉0．05）；（2）CIMT增厚组病程、平均血糖波动幅度、平均血糖标准差、血糖波动频数、日间血糖波动幅度、动脉粥样硬化积分分别为（11．5±7．3）年、（6．9±3．0）mmol／L、（2．8±1．2）mmol／L、（3．4±1．5）次／d、（2．8±1．3）mmol/L和（4．5±1．0）分，CIMT正常组分别为（8±6）年、（4．2±1．1）mmol／L、（1．6±0．5）mmol／L、（2．2±0．8）次／d、（2．0±1．0）mmol/L和（3．3±0．6）分，两组比较差异均有统计学意义（t值分别为0．31、0．53、0．22、0．35、0．37、0．44，均P〈0．05）；（3）CIMT与平均血糖波动幅度、血糖波动频数、日间血糖波动幅度、病程、舒张压、LDL—C、餐后2h平均血糖、动脉粥样硬化积分均呈正相关（r值为0．30—0．53，均P〈0．05）；④CIMT与平均血糖波动幅度、餐后2h平均血糖显著相关，以CIMT为因变量，各相关因素为自变量，只有平均血糖波动幅度、餐后2h平均血糖最终进入回归方程。结论2型糖尿病患者的CIMT水平与血糖波动密切相关，减少血糖波动、降低平均血糖波动幅度和餐后2h平均血糖水平可能有延缓糖尿病大血管病变的作用。Objective To investigate the correlation between carotid intima-media thickness （CIMT） and glucose fluctuation in patients with type 2 diabetes mellitus （T2DM）. Methods Sixty-eight T2DM patients admitted to Beijing Military General Hospital from March to August 2012 were enrolled in the study, including 32 cases with CIMT thickening （CIMT ≥ 0. 9 mm ） and 32 cases with normal CIMT （CIMT 〈0. 9 mm）. The 72 h continuous blood glucose levels were monitored from the day of admission. Results There were no significant differences in the gender, age, body mass index （ BMI）, systolic and diastolic blood pressure, HDL-C, LDL-C, CHO, TG, glycosylate hemoglobin （HbAlc）, fasting blood glucose （FBG） and postprandial average blood glucose （MPBG） between two groups （ P 〉 0. 05 ）. The atherosclerosis （AS） score and mean amplitude of glycemic excursion （MAGE）, glucose standard deviation, frequency of glycemic excursion （FGE） and absolute mean of daily differences （MODD） in patients with thickening CIMT were （ 11 ±7） years, （6. 9 ±3. 0） mmol/L, （2. 8 ± 1.2） mmol/L, （3.4 ± 1.5） times/d, （2. 8 ± 1.3） mmol/L, （4. 5 ± 1.0） score,respectively; while those in patients with normal CIMT were （8 ± 6 ） years, （4. 2 ± 1.1 ） mmol/L, （ 1.6 ± 0. 5 ） mmol/L, （2. 2 ± 0. 8 ） times/d, （2. 0 ± 1.0） mmol/L, （ 3.3 ± 0. 6） score, respectively. There were significant differences between two groups （ all P 〈 0. 05 ）. Pearson correlation showed that CIMT was positively correlated with MAGE, FGE, MODD, course of disease, diastolic blood pressure, LDL-C, MPBG and AS score （ P 〈 0. 05 ）. Multiple stepwise regression analysis showed that MAGE, MBPG were the influencing factors of CIMT. Conclusions The CIMT of patients with T2DM is closely correlated with glucose fluctuation, indicating that reduction of blood glucose fluctuation and MAGE, MPBG levels may delay the occurrence of diabetic macroangiopathy.

关 键 词：糖尿病 2型 血糖波动 动态血糖监测系统 颈动脉内膜中层厚度 

分 类 号：R587.1[医药卫生—内分泌]