波动性高血糖和持续性高血糖对2型糖尿病患者血管并发症的影响  

Impact of fluctuating and persistent hyperglycemia on vascular complications in patients with type 2 diabetes mellitus

作　　者：朱晨希 李丽燕 赵旭东 郝敬波 李雷 ZHU Chenxi;LI Liyan;ZHAO Xudong;HAO Jingbo;LI Lei(Department of General Practice,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;不详)

机构地区：[1]徐州医科大学附属医院全科医学科,江苏徐州221002 [2]徐州医科大学附属医院老年医学科

出　　处：《中华全科医学》2024年第9期1463-1466,共4页Chinese Journal of General Practice

基　　金：江苏省老年健康科研项目(LK2021015)。

摘　　要：目的观察波动性高血糖和持续性高血糖对2型糖尿病(T2DM)患者血管并发症的影响,探讨其可能的机制。方法选择2022年11月—2023年5月在徐州医科大学附属医院新诊断的112例T2DM患者,根据平均血糖波动幅度(MAGE)分为持续性高血糖组(52例)与波动性高血糖组(60例),评估大血管、微血管并发症。结果波动性高血糖组较持续性高血糖组2 h血糖、2 h胰岛素、颈动脉内膜中层厚度(IMT)明显升高(P<0.05),高敏C反应蛋白(hs-CRP)、尿白蛋白/尿肌酐(UACR)、肱动脉内皮依赖性舒张功能(EDD)、踝肱指数(ABI)明显降低(P<0.05);冠心病[30.0%(18例)vs.13.5%(7例),χ^(2)=4.394,P=0.036]和脑梗死发生率[26.7%(16例)vs.11.5%(6例),χ^(2)=4.039,P=0.044]增高,糖尿病肾病[10.0%(6例)vs.25.0%(13例),χ^(2)=4.450,P=0.035]及糖尿病视网膜病变发生率[8.3%(5例)vs.23.1%(12例),χ^(2)=4.703,P=0.030]降低。多因素logistic回归分析显示:大血管并发症影响因素为2 h血糖、2 h胰岛素、MAGE>3.9 mmol/L、肱动脉EDD(P<0.05);微血管并发症影响因素为空腹血糖、糖化血红蛋白、MAGE≤3.9 mmol/L、hs-CRP(P<0.05)。结论波动性高血糖对T2DM患者大血管并发症影响更明显,可能与内皮功能受损有关,而持续性高血糖对T2DM患者微血管并发症影响更显著,可能与炎性反应有关。ObjectiveTo observe the effects of fluctuating hyperglycemia and persistent hyperglycemia on macrovascular and microvascular complications in patients with type 2 diabetes and explore the possible mechanisms.MethodsA total of 112 patients with newly diagnosed type 2 diabetes mellitus who were hospitalized in the Affiliated Hospital of Xuzhou Medical University from November 2022 to May 2023 were selected and divided into two groups,52 patients in the persistent hyperglycemia group and 60 patients in the fluctuating hyperglycemia group according to the mean amplitude of glycemic excursions(MAGE).Macrovascular and microvascular complications were assessed.ResultsThe fluctuating hyperglycemia group had higher 2 h blood glucose,2 h insulin,carotid intimamedia thickness(IMT)than the sustained hyperglycemia group(P<0.05),while highsensitivity Creactive protein(hs-CRP),urinary albumin urine creatinine(UACR),brachial endotheliumdependent diastolic function(EDD),and ankle brachial index(ABI)were significantly lower(P<0.05).Rates of coronary heart disease[30.0%(18 cases)vs.13.5%(7 cases),χ^(2)=4.394,P=0.036]and rates of cerebral infarction[26.7%(16 cases)vs.11.5%(6 cases),χ^(2)=4.039,P=0.044]increased,peripheral arteriosclerosis worsened,and diabetic nephropathy[10.0%(6 cases)vs.25.0%(13 cases),χ^(2)=4.450,P=0.035]and diabetic retinopathy[8.3%(5 cases)vs.23.1%(12 cases),χ^(2)=4.703,P=0.030]decreased.Multivariate logistic regression analysis showed that the influencing factors of macrovascular complications were 2 h blood glucose,2 h insulin,MAGE>3.9 mmol/L,and brachial EDD(P<0.05).The contributing factors for microvascular complications were fasting glucose,glycated hemoglobin,MAGE≤3.9 mmol/L,and hs-CRP(p<0.05).ConclusionFluctuating hyperglycemia has a greater influence on macrovascular complications in patients with type 2 diabetes,possibly due to impaired endothelial function,whereas sustained hyperglycemia has a stronger impact on microvascular complications,which could be linked to inflammatory responses.

关 键 词：2型糖尿病 波动性高血糖 内皮功能 动脉粥样硬化 炎性反应 

分 类 号：R587.1[医药卫生—内分泌]