“黎明现象”不同诊断标准比较及其对血糖波动的影响  

The comparison of different quantitative criteria of the Dawn Phenomenon and its impact on blood glucose fluctuation in type 2 diabetes

作　　者：杨少华[1] 许杰[1] 王靖宇[1] 韩菲[1] 张祎[1] 杨笑云 郭振红[1] 常柏[1] 杨菊红[1] 单春艳[1] 常宝成[1] 陈莉明[1] 郑妙艳[1] 

机构地区：[1]卫生部激素与发育重点实验室,天津医科大学代谢病医院糖尿病肾病科,300070

出　　处：《中华内分泌代谢杂志》2016年第2期117-120,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金（81373864,81473622,81200612）;天津市自然科学基金（14JCYBJC26200,15JCYBJC50300）

摘　　要：选取128例2型糖尿病患者进行为期3天的动态血糖监测，分别按照（1）空腹血糖与夜间血糖最低点的差值（？G）≥20 mg／dl、（2）？G≥10 mg／dl及（3）胰岛素增量≥20％来定义“黎明现象”，分别统计其发生率，比较24 h 平均血糖水平标准差（ SDBG ），高血糖曲线下面积（ AUC ），平均血糖波动幅度（ MAGE）等在“黎明现象”组与对照组的变化。？G≥20 mg／dl、≥10 mg／dl及胰岛素增量≥20％时“黎明现象”的发生频率分别为64．8％、85．2％、59．4％；？G≥20 mg／dl及胰岛素增量≥20％时，SDBG、AUC、MAGE及MODD均较对照组升高（P＜0．05）；而？G≥10 mg／dl时，与对照组差异未见统计学意义（P＞0．05）；“黎明现象”的发生频率与HOMA-IR、HbA1C及空腹C肽水平呈正相关（P＜0．05）。“黎明现象”在2型糖尿病患者中发生频率很高，不仅影响整体血糖控制，更加剧血糖波动。差值≥20 mg／dl的定义标准与临床诊断、治疗关系更为密切。[Summary] A total of 128 individuals with type 2 diabetes underwent continuous glucose monitoring for 3 consecutive days.The dawn phenomenon was defined by three different parameters according to the previous research：（1）the absolute increase of glucose level from nocturnal nadir to prebreakfast value（？G） above 20 mg/dl;（2）？G above 10 mg/dl;（ 3 ） insulin requirement increased at least 20%.The participants were secondarily separated by presence/absence of a dawn phenomenon based on the definitions above.The impact on blood glucose fluctuation of different groups was assessed according to the standard deviation of blood glucose（ SDBG） , the area under curve above 10 mmol/L （ AUC ） , and the mean amplitude of glycemic excursions （ MAGE ） , etc.The frequencies of dawn phenomenon were 64.8%（？G≥20mg/dl）, 85.2%（？G≥10 mg/dl）, and 59.4%（rise in insulin requirement≥20%）respectively.The impacts on SDBG, AUC, MAGE, and MODD were without statistical difference（P〉0.05） between the presence and absence of the dawn phenomenon patients when？G≥10 mg/dl.However, the differences reached statistical significance（P〈0.05） when ？G≥20 mg/dl and the increase in insulin requirement≥20%. Besides, the incidence of dawn phenomenon was positively correlated with HOMA-IR, HbA1C , and free C-peptide.Dawn phenomenon is a very frequent event in type 2 diabetes and not only impacts the overall glycemic control but also exaggerates glucose fluctuation.To be clinically relevant, ？G≥20mg/dl should be taken as the quantitative criterion of the dawn phenomenon.

关 键 词：2型糖尿病 黎明现象 发生频率 动态血糖监测 血糖波动 

分 类 号：R587.2[医药卫生—内分泌]