2型糖尿病合并冠心病患者血糖波动与冠状动脉病变的相关性研究  

Study on correlation of type2 diabetic combined with blood glucose fluctuations in patients with coronary heart disease and coronary artery lesions

作　　者：丁林[1] 吕肖锋[1] 武晋晓[1] 张星光[1] 程千鹏[1] 

机构地区：[1]安徽医科大学北京军区总医院临床学院,北京100007

出　　处：《重庆医学》2015年第17期2344-2346,2350,共4页Chongqing medicine

基　　金：国家科技重大专项子课题(2011ZX09307-001-08)

摘　　要：目的探讨2型糖尿病(T2DM)合并冠心病(CHD)的患者血糖波动对冠状动脉病变的影响。方法选取80例2013年6月至2014年3月在北京军区总医院内分泌科住院的T2DM患者为研究对象,其中合并CHD患者50例(CHD&DM组)。单纯2型糖尿病患者30例(DM组)。应用动态血糖监测系统(CGMS)对两组患者行连续72h血糖监测并计算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)、最大血糖波动幅度(LAGE),同时测定血浆高迁移率族蛋白B1(HMGB1)、血管性假血友病因子(vWF)的水平,比较两组间HMGB1、vWF的水平及血糖波动参数,探讨T2DM合并CHD患者与单纯T2DM在血糖波动、HMGB1、vWF的差异及其在冠状动脉病变中的意义。结果 CHD&DM组的病程、MAGE、LAGE、MPPGE、MODD、vWF、HMGB1水平明显高于DM组,差异有统计学意义(P<0.05)。按照Gensini冠状动脉评分将CHD&DM组分为3组,其中A、B、C 3组的Gensini评分差异均有统计学差异(P<0.05)。C组及B组MAGE、LAGE、MPPGE、MODD、HMGB1、vWF水平较A组高(P<0.05),C组的水平较B组高(P<0.05)。Pearson相关分析表明:Gensini评分与MAGE、LAGE、MODD、MPPGE、vWF、HMGB1、年龄、TC呈正相关(r=0.267、0.341、0.533、0.529、0.635、0.691、0.226、0.106,P<0.05)。多元逐步回归分析发现:Gensini评分=342.865+35.117MAGE+14.821HMGB1+7.927vWF。结论血糖波动对DM合并CHD的发病有一定的影响,其机制可能是通过内皮损伤及炎性反应而引起。Objective To discuss the impact of glucose excursion on coronary artery stenosis in type 2diabetic patients with coronary heart disease.Methods Eighty patients diagnosed with type 2diabetic during June 2013 to March 2014 were selected as the research cases.50cases（28males and 22females）,aged（61.73±4.36）years were merged with coronary heart disease（group CHDDM）,and 30cases（male 19 cases and 11females）,aged（62.11±2.65）years were not merged with coronary heart disease（group DM）.Continuous glucose monitoring system（CGMS）was used to monitor and calculate the CGMS parameters of all patients in 72 hours,such as mean amplitude of glycemic excursions（MAGE）,the largest amplitude of glycemic excursions（LAGE）,mean postprandial glucose excursion（MPPGE）,absolute means of daily differences（MODD）,meanwhile measure the levels′of high mobility group proteins（HMGB1）and von willebrand factor（vWF）.Comparson of the levels of HMGB1,vWF and blood glucose fluctuation parameters between the two groups was performed,and then analysis of the correlations among blood glucose fluctuation parameters,clinical biochemical and Gensini score was done.Results When compared with group DM,levels of disease course,MAGE,LAGE,MPPGE,MODD,HMGB1,vWF in group CHDDM were higher（P0.05）.According to the Gensini scores,CHDDM group was divided the into A,B,C groups and among the 3groups,the difference was statistically significant（P0.05）.The levels of MAGE,LAGE,MPPGE,MODD,HMGB1,vWF in group B and C was significantly higher than group B（P0.05）,meanwhile,the difference between group C and group B was also statistically significant（P0.05）.Correlation analysis showed that the levels of MAGE,LAGE,MODD,MPPGE,vWF,HMGB1,age,TC in CHDDM group was significantly related to the Gensini score（r=0.267,0.529,0.533,0.341,0.635,0.691,0.226,0.106,P0.05）.Multiple stepwise regression analysis showd that MAGE,vWF,HMGB1 were dependent risks to Gensini score（Y=342.865＋35.117MAGE＋14.821HMGB1＋7.927vWF）

关 键 词：糖尿病 2型 冠状动脉疾病 血糖 高迁移率族蛋白质类 血管性假血友病因子 

分 类 号：R587.1[医药卫生—内分泌]