2型糖尿病患者不同时间血糖与糖化血红蛋白的相关性及其贡献  

Contributions of pre- and post-prandial blood glucose to glycosylated hemoglobin Alc and theircorrelation analysis in patients with type 2 diabetes

作　　者：鞠海兵[1] 舒子正[1] 李丽凤[1] 宋洁[1] 陈志娟[1] 阮兆娟[1] 陈瑛[1] 

机构地区：[1]昆明,成都军区昆明总医院内分泌科,650032

出　　处：《中华糖尿病杂志》2014年第1期32-36,共5页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的探讨2型糖尿病患者不同时间点血糖与糖化血红蛋白（HbAlc）的相关性及不同治疗方式时餐前和餐后血糖对HbAIc的贡献。方法选择2010年6月至2012年10月就诊的病程超过1年、治疗相对稳定的2型糖尿病患者256例，男119例，女137例，年龄（54±14）岁，平均病程4．5年，平均空腹血糖9．6mmol／L，平均HbAlc8．4％。按治疗方式不同将患者分为口服药物治疗组（84例）、基础胰岛素治疗组（80例）和预混胰岛素治疗组（92例）。各组再根据HbAlc的不同分成HbAlc〈7％组、7％≤HbAlc〈8％组、8％≤HbAlc〈9％组、HbAlc≥9％组。不连续3d监测全天三餐前后和睡前7个时问点的血糖谱，取3d的平均值，同时免疫比浊法测定HbAlc。对各个时间点血糖与HbAIc进行单因素相关分析。三餐前及睡前四点血糖连线与正常血糖5．6mmoUL平行线：岂间的面积为餐前血糖面积，三餐前和睡前四点血糖连线与三餐后血糖连线间的面积为餐后血糖面积，根据餐前血糖或餐后血糖面积与总高血糖面积的比值计算口服药物、基础胰岛素和预混胰岛素治疗组餐前和餐后血糖对HbAlc的贡献。结果本组患者各个时间点血糖与HbAlc水平存在明显相关性（r=0．38-0．76，均P〈0．05），7点平均血糖与HbAlc相关性最强（r≥0．71，P〈0．05）。口服药物治疗组餐前、餐后血糖对HbAlc的贡献分别为59％-82％、18％～41％；预混胰岛素治疗组餐前、餐后血糖对HbAlc的贡献分别为60％-82％、18％～40％；基础胰岛素治疗组餐前、餐后血糖对HbAIc的贡献分别为38％～66％、34％～62％。趋势检验表明，口服药物、基础胰岛素和预混胰岛素治疗组餐前血糖对HbAlc的相对贡献随着HbAlc的增加而增加（F=67，46、168．51、84．05，均P〈0．05），餐后血糖的相对贡献则相反。基础胰岛素治疗组在不同HbAIc状态下餐前血糖相对贡献较预混胰�subdivided according to HbAlc levels： 〈 7% group, 7% ~〈 ＆ 〈 8% group, 8% 〈~ ＆ 〈 9% group, t〉9% group. The average of seven-point blood glucose from self-monitored blood glucose （SMBG） from three non- consecutive days was calculated and plotted on glucose-time graph. Meanwhile HbA1 c was measured with immunoassay and the correlation between seven-point blood glucose and HbAlc levels was evaluated using Pearson＇s correlation analysis. On the glucose-time curse, a curve was drawn to connect the three points representing preprandial glucose and the one point representing bedtime glucose. The area between this curve and the horizontal line at 5.6 mmol/L was calculated as the preprandial glucose volume. Another curve （postprandial） was also drawn to connect the three points representing postprandial glucose and the area between preprandial curve and postprandial curve was calculated as postprandial glucose volume. The contribution of pre- and post-prandial glucose to HbAI c was determined by the ratio of pre- and post-prandial glucose volume over total glucose volume （pre- and post-prandial glucose volume together）. Results There were significant correlation between HbA1 c levels and seven-point seK-monitored blood glucose （r = 0. 38 to 0. 76, all P 〈0. 05）, and the mean of all seven-point blood glucose had the highest correlation with HbAlc in all treatment groups （ r~〉0. 71, P 〈 0. 05 ）. The contribution of pre and post prandial glucose to HbAI c was 59% - 82% , 18% - 41% in oral drug treatment group, 60% - 82% , 18% - 40% in basal insulin treatment group and 38% - 66%, 34% - 62% in pre-mixed insulin treatment group. Tendency analysis showed that the relative contribution of preprandial hyperglycemia increased gradually with increasing values of HbA1 c in diabetic patients treated with oral drug and basal insulin and premixed insulin （ F = 67.46, 168.51, 84.05, P 〈 0. 05 ） , but the relative contribution of postprandial hyperglycemia showed a gradual decrease with i

关 键 词：糖尿病 2型 血红蛋白A.糖基化 高血糖 

分 类 号：R587.1[医药卫生—内分泌]