糖化血红蛋白控制达标的2型糖尿病患者血糖波动与微血管并发症的相关性研究  

Correlation between glycemic fluctuation and microvascular complication in type 2 diabetic patients with well-controlled glycosylated hemoglobin

作　　者：魏嘉洁[1] 文丽娜[1] 周迎生[1] Wei Jiajie;Wen Lina;Zhou Yingsheng(Department of Endocrinology and Metabolism,Belting Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院内分泌代谢科,100029

出　　处：《中国医药》2018年第11期1682-1685,共4页China Medicine

基　　金：国家自然科学基金(81641027);北京市科技计划(Z131100004013044);北京市卫生系统高层次卫生技术人才培养计划(2013-2-006)~~

摘　　要：目的探讨糖化血红蛋白(HbA1c)控制达标的2型糖尿病患者24 h动态血糖变化与微血管并发症之间的相关性。方法选取2012年9月至2017年12月就诊于首都医科大学附属北京安贞医院的2型糖尿病患者共66例,所有患者HbA1c <7%,根据是否合并微血管并发症分为未合并微血管并发症组(A组,35例)和合并微血管并发症组(B组,31例)。检测所有患者HbA1c、空腹血糖、血脂、肝肾功能指标。用动态血糖监测系统监测全天血糖情况,记录指标包括平均血糖波动幅度(MAGE)、平均血糖标准差(SDBG)、24 h内平均血糖(MBG)、血糖最高值、血糖最低值、最大血糖波动幅度(LAGE)、M值、平均日风险范围(ADRR)。结果 A组与B组间空腹血糖、HbA1c差异无统计学意义(P>0.05)。B组MAGE、SDBG、MBG、血糖最高值、LAGE、M值、ADRR均明显高于A组[(4. 6±2. 1)mmol/L比(2. 9±1.1)mmol/L、(1. 7±0. 7) mmol/L比(1. 3±0. 4) mmol/L、(8. 0±1.7) mmol/L比(7. 2±1. 1) mmol/L、(12. 5±3. 2) mmol/L比(10.2±1. 6)mmol/L、(7. 8±3. 3) mmol/L比(5. 6±1.9) mmol/L、3. 6(2.0,8.9)比2. 1 (1. 0,3.7)、(18±12)比(9±5)],差异均有统计学意义(均P<0. 05)。Spearman相关分析结果显示,MAGE与空腹C肽和三酰甘油水平呈明显负相关(r=-0.265、-0. 280,均P<0.05)。Logistic回归分析结果显示,MAGE是2型糖尿病患者发生微血管并发症的危险因素(比值比=1.917,P<0.01)。结论血糖波动是HbA1c控制达标的2型糖尿病患者发生微血管并发症的危险因素。Objective To analyze the correlation between glycemic fluctuation and microvascular complication in type 2 diabetic patients with glycosylated hemoglobin（HbA1c）〈7%. Methods Sixty-six type 2 diabetic patients with HbA1c〈7% were enrolled from September 2012 to December 2017 in Beijing Anzhen Hospital, Capital Medical University; 35 patients had microvascular complication（group A）; 31 patients without microvascular complication were group B. HbA1c, fasting blood glucose, blood lipid, liver and kidney function indexes were tested. Mean amplitude of glycemic excursions（MAGE）, mean standard deviation of blood glucose（SDBG）, 24 h mean blood glucose（MBG）, maximum and minimum blood glucose, the largest amplitude of glycemic excursions（LAGE）, M value and average daily risk range（ADRR） were monitored by the continuous glucose monitoring system. Results Fasting blood glucose and HbA1c level showed no significant difference between the group A and group B（P〉0.05）. MAGE, SDBG, MBG, maximum blood glucose, LAGE, M value and ADRR in the group B were significantly higher than those in the group A[（4.6±2.1）mmol/L vs （2.9±1.1）mmol/L, （1.7±0.7）mmol/L vs （1.3±0.4）mmol/L, （8.0±1.7）mmol/L vs （7.2±1.1）mmol/L, （12.5±3.2）mmol/L vs （10.2±1.6）mmol/L, （7.8±3.3）mmol/L vs （5.6±1.9）mmol/L, 3.6（2.0,8.9） vs 2.1（1.0,3.7）, （18±12） vs （9±5）]（P〈0.05）. Spearman test showed that MAGE was negatively correlated with levels of fasting C-peptide and triglyceride（r=-0.265, -0.280; P〈0.05）. Logistic regression indicated that MAGE was a risk factor of microvascular complication（odds ratio=1.917, P〈0.01）. Conclusion Blood glucose fluctuation is an independent risk factor of microvascular complication in type 2 diabetic patients with HbA1c〈7%.

关 键 词：2型糖尿病 动态血糖监测 血糖波动 微血管并发症 

分 类 号：R587.1[医药卫生—内分泌]