血糖波动对2型糖尿病下肢血管病变患者血管内皮功能的影响及危险因素分析  

Influence of Blood Sugar Fluctuation on Endothelia-dependent Flow-Mediated Dilatation in Patients with Type 2 Diabetes Mellitus Complicated with Lower Limb Vascular Lesion and Analysis of Risk Factors

作　　者：王亚双[1,2] 吕肖锋[1] 张敏郁[3] 彭永[1] 陈少敏[1] 马艳霞[1] 丁林[1] 

机构地区：[1]北京军区总医院内分泌科,北京100700 [2]山西医科大学研究生学院,太原030001 [3]北京军区总医院超声科,北京100700

出　　处：《解放军医药杂志》2014年第8期21-24,28,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：国家科技重大专项子课题(2011ZX09307-001-08)

摘　　要：目的探讨血糖波动对2型糖尿病(T2DM)合并下肢血管病变患者血管内皮功能(FMD)的影响,并对相关危险因素进行分析。方法选择2013年3月—2014年4月在北京军区总医院内分泌科住院治疗且符合纳入标准的T2DM患者49例,按照超声检测是否合并下肢血管病变分为T2DM合并下肢血管病变组(A组)29例、单纯T2DM组(B组)20例。对两组分别行72 h动态血糖监测,测得动态血糖参数:日内平均血糖波动幅度(MAGE),最大血糖波动幅度(LAGE),全天血糖标准差(SDBG),日间血糖平均绝对差(MODD),平均餐后血糖波动幅度(MPPGE)。同时检测两组肱动脉血压、FMD及血脂、同型半胱氨酸(Hcy)、丙二醛(MDA)、糖化血红蛋白(HbA1c)等临床生化指标,比较两组间各指标的差异。对FMD与各观察指标进行相关分析。结果 1A组收缩压(SBP)、TC、TG、低密度脂蛋白胆固醇(LDL-C)、HbA1c、Hcy、MDA显著高于B组(P<0.05),FMD较B组明显降低(P<0.05)。2A组MAGE、LAGE、SDBG、MODD、MPPGE显著高于B组(P<0.05)。3FMD与SBP、LDL-C、HbA1c、Hcy、MDA、TC、TG、MAGE、SDBG、MODD、MPPGE呈显著负相关(r=-0.355,-0.272,-0.337,-0.345,-0.320,-0.345,-0.302,-0.418,-0.475,-0.312,-0.387,-0.313,P<0.05,P<0.01)。4多元逐步回归分析结果:MODD、Hcy、TC是影响FMD的独立危险因素(Y=8.390-0.117Hcy-0.316TC-0.495MODD)。结论血糖波动与T2DM下肢血管病变患者FMD关系密切。Hcy与血糖波动相关,可能通过氧化应激作用参与对FMD的损害。Objective To investigate the influence of blood glucose fluctuation on endothelia-dependent flow-mediated dilatation （FMD） patients with type 2 diabetes mellitus （T2DM） complicated with lower extremity vascular le-sion and to analyze the related risk factors. Methods A total of 49 patients with T2DM during March 2013 and April 2014 were enrolled in the study. According to the occurrence of lower extremity atherosclerosis by color Doppler ultra-sound, the patients were divided into T2DM patients with lower extremity vascular disease （group A, n=29） and pa-tients with T2DM （group B, n=20）. The 72 h continuous glucose monitoring were performed respectively for the two groups to detect the glucose parameters, such as mean amplitude of glycemic excursions （ MAGE） , largest amplitude of glycemic excursions （ LAGE） , standard deviation of blood glucose （ SDBG） of one day, absolute means of daily differ-ence （ MODD） and mean postprandial glucose excursion （ MPPGE） , and the values of brachial artery blood pressure, FMD, blood fat, homocysteine （Hcy）, malondialdehyde （MDA） and glycosylated hemoglobin （HbA1c） which were de-tected at the same time, and then the difference of each index in two groups was compared respectively. The correlation between FMD with the indexes was analyzed. Results ① The levels of systolic blood pressure （SBP）, TG, TC low＆amp;nbsp;density lipoprotein cholesterol （LDL-C）, HbA1c, Hcy and MDA in group A were significantly higher than those in group B （P〈0. 05）, while the FMD value was significantly lower than that in group B （P〈0. 05）; ②the levels of MAGE, LAGE, SDBG, MODD and MPPGE in group A were significantly higher than those in group B （P〈0. 05）. ③The FMD value had significantly negative relationship with values of SBP, LDL-C, HbA1c, Hcy, MDA, TC, TG, MAGE, SDBG, MODD and MPPGE （r= -0. 355, -0. 272, -0. 337, -0. 345, -0. 320, -0. 345, -0. 302, -0. 418, -0. 475,-0. 312, -0. 387, -0. 313;P〈0. 05, P〈0. 01）. �

关 键 词：糖尿病 2型 血糖波动 血管内皮依赖性舒张功能 下肢血管病变 动态血糖监测 同型半胱氨酸 丙 二醛 

分 类 号：R587.29[医药卫生—内分泌]