胰岛素治疗的2型糖尿病患者适量饮酒后的血糖波动及其影响因素  

Effect of moderate alcohol intake on acute glycemic excursion in insulin-treated type 2 diabetics

作　　者：吴秋霞[1,2] 蒋兰兰[1,2] 沈赟[1,2] 张文礼[1,2] 罗勇[1,2] 袁璐[1,2] 许向红[1,2] 陈颖越[1,2] 马建华[1,2] 吴锦丹[1,2] 

机构地区：[1]湖北省荆门市第二人民医院内分泌科 [2]南京医科大学附属南京医院(南京市第一医院)内分泌科,210006

出　　处：《中华内分泌代谢杂志》2014年第7期569-572,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：南京市卫生局课题（YKKllll8）

摘　　要：研究适量饮酒对胰岛素治疗的2型糖尿病患者的急性血糖波动及其影响因素.男性2型糖尿病患者40例,经胰岛素泵治疗血糖控制平稳后,通过动态血糖监测比较连续2d分别饮用等量的水和适量白酒对24 h血糖波动的影响,并通过比较次日空腹C肽、胰升糖素、生长激素和皮质醇水平,探讨适量饮酒影响急性血糖波动的因素.结果发现患者随晚餐适量饮酒后24 h与饮用等量水后24 h相比,除24 h平均血糖值（MBG）降低（P＜0.05）,最大血糖波动幅度（LAGE）、血糖水平标准差（SDBG）、变异系数（CV）、平均血糖波动幅度（MAGE）、日内血糖波动次数（NGE）、低血糖时间百分比（PT1）、高血糖时间百分比（PT3）差异均无统计学意义;同时与饮水后比较,饮酒后次日空腹生长激素水平显著降低（P＜0.05）.1例患者饮酒后出现夜间持续性低血糖,25例饮酒后24 h无低血糖发生（无低血糖组）,15例饮酒后发生低血糖（低血糖组）.与无低血糖组相比,低血糖组空腹C肽和餐后2hC肽均较低（P＜0.05）,且饮酒日晚餐前血糖和次日空腹血糖均较低（P＜0.05）.无低血糖组饮酒后次日空腹生长激素水平较饮水后降低（P＜0.05）,低血糖组饮酒后次日空腹胰升糖素较饮水后升高（P＜0.05）.胰岛素治疗的2型糖尿病患者随餐适量饮酒总体对血糖波动无明显影响,但胰岛功能相对较差、晚餐前血糖较低及既往有低血糖史的患者仍需警惕低血糖的发生;在不发生低血糖的前提下,适量饮酒可能通过对生长激素的抑制作用而有益于血糖控制.The effect of moderate alcohol intake on acute glycemic excursion in type 2 diabetes treated with insulin pump and the relevant factors were explored.Forty male type 2 diabetic patients were treated by insulin pump to achieve steady glucose control.Then they took the same amount of water on the first day along with food and moderate alcohol on the second day.24 h glycemic excursions during the two consecutive days were observed by means of continuous glucose monitor system.Blood C-peptide （C-P）,glucagon,growth hormone （GH）,and cortisol were determined on the next morning,24 h prior to,and 24 h after taking alcohol.The results showed that 24 h mean blood glucose（MBG） was decreased （P〈0.05） after taking alcohol.Compared with water drinking group,blood GH was decreased in the next morning after drinking alcohol （P 〈 0.05）.One case developed persistent nocturnal hypoglycemia after drinking moderate amount of alcohol.25 cases showed no hypoglycemia （termed as nonhypoglycemia group）,and 15 cases developed hypoglycemia after drinking alcohol （termed as hypoglycemia group）.The fasting C-P and 2 h C-P,preprandial blood glucose,and the next day fasting blood glucose following drinking alcohol in hypoglycemia group were lower than those in the non-hypoglycemia group （P〈0.05）.In nonhypoglycemia group,GH on the next morning after drinking alcohol was decreased （P 〈 0.05）.In hypoglycemia group,glucagon on the next morning after drinking alcohol was increased.Moderate alcohol intake with food in patients with type 2 diabetes treated with insulin pump usually did not yield acute glycemic excursion.But patients with relevant poor islet function,lower preprandial blood glucose,and a history of hypoglycemia should be alrty of the alcohol-induced hypoglycemia.By inhibition of GH,moderate alcohol consumption may exert some beneficial effects on glucose control.

关 键 词：饮酒 糖尿病 2型 血糖波动 动态血糖监测 DIABETES MELLITUS type 2 

分 类 号：R587.1[医药卫生—内分泌]