持续动态血糖监测下2型糖尿病患者的血糖指标和周围神经病变的相关性  

Correlation analysis of glycemic index and peripheral neuropathy in patients with type 2 diabetes mellitus under continuous glucose monitoring

作　　者：范学明 杨宁宁 郑振 吴玉梅 何春远 王祺 Fan Xueming;Yang Ningning;Zheng Zhen;Wu Yumei;He Chunyuan;Wang Qi(Department of Endocrinology,Lu′an Hospital Affiliated to Anhui Medical University,Lu′an 237005,China)

机构地区：[1]安徽医科大学附属六安医院内分泌科,六安237005

出　　处：《中国医师杂志》2025年第3期361-366,共6页Journal of Chinese Physician

基　　金：安徽省教育厅科研项目(2023AH050621)。

摘　　要：目的分析持续动态血糖监测下2型糖尿病患者的血糖指标和周围神经病变的相关性。方法回顾性纳入安徽医科大学附属六安医院2022年11月—2024年1月收治的2型糖尿病患者110例进行观察,均采用动态血糖仪监测患者血糖指标[葡萄糖目标范围内时间(TIR)、平均葡萄糖值(MBG)、预估糖化血红蛋白(eHbA_(1c))、血糖标准差(SD)、血糖变异系数(CV)、最大血糖波动幅度(LAGE)、平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)等]。所有2型糖尿病患者按是否合并周围神经病变进行分组,分为发生组和未发生组,统计并整理两组患者一般资料和血糖指标,采用受试者工作特征(ROC)曲线分析各项血糖指标预测2型糖尿病患者并发周围神经病变的价值,另选择Spearman相关性分析评估血糖指标和周围神经病变的相关性。结果发生组的病程、TIR、MBG、eHbA_(1c)、SD、CV、LAGE、MAGE、MODD和未发生组差异有统计学意义(均P<0.05)。通过绘制ROC曲线发现血糖指标TIR、MBG、eHbA_(1c)、SD、CV、LAGE、MAGE、MODD预测2型糖尿病患者并发周围神经病变的曲线下面积(AUC)分别是0.942、0.840、0.705、0.759、0.819、0.813、0.857、0.677,联合预测的AUC为0.971(95%CI:0.946~0.997),相较于单一指标更高(均P<0.05)。Spearman相关性评估结果显示TIR和周围神经病变呈负相关性(r=-0.738,P<0.05),MBG、eHbA_(1c)、SD、CV、LAGE、MAGE、MODD则和周围神经病变呈正相关性(r=0.554,0.376,0.452,0.490,0.527,0.625,0.272,均P<0.05)。结论基于持续动态血糖监测下,2型糖尿病患者的血糖指标和周围神经病变存在密切关系,同时上述血糖指标又可对周围神经病变进行准确预测,为减少或者预防周围神经病变的发生提供参考依据。ObjectiveTo analyze the correlation between blood glucose index and peripheral neuropathy in type 2 diabetes patients under continuous blood glucose monitoring.MethodsA total of 110 patients with type 2 diabetes admitted to the Lu′an Hospital Affiliated to Anhui Medical University from November 2022 to January 2024 were retrospectively observed,and the blood glucose indexes of patients were monitored by continuous glucose meter[glucose time in range(TIR),mean blood glucose(MBG),estimated hemoglobin A_(1c)(eHbA_(1c)),blood glucose standard deviation(SD),coefficient of variation(CV),largest amplitude of glycemic excursions(LAGE),mean amplitude of glycemic excursions(MAGE),means of daily differences(MODD),etc].All patients with type 2 diabetes were grouped according to whether they had peripheral neuropathy or not,and were divided into the developing group and the non-developing group.General data and blood glucose indexes of the two groups were collected and sorted out.Receiver operating characteristic(ROC)curve was used to analyze the value of various blood glucose indicators in predicting peripheral neuropathy in patients with type 2 diabetes.Spearman correlation analysis was also used to evaluate the correlation between blood glucose index and peripheral neuropathy.ResultsThe disease course,TIR,MBG,eHbA_(1c),SD,CV,LAGE,MAGE and MODD of the occurrence group were significantly different from those of the non-occurrence group(all P<0.05).By plotting the ROC curve,It was found that the area under the curve(AUC)of TIR,MBG,eHbA_(1c),SD,CV,LAGE,MAGE and MODD predicting peripheral neuropathy in patients with type 2 diabetes were 0.942,0.840,0.705,0.759,0.819,0.813,0.857 and 0.677,respectively.The AUC of the combined prediction was 0.971(95%CI:0.946-0.997),which was higher than that of the single indicator(all P<0.05).Spearman correlation assessment showed a negative correlation between TIR and peripheral neuropathy(r=-0.738,P<0.05).MBG,eHbA_(1c),SD,CV,LAGE,MAGE and MODD were positively correlated with peripheral neuro

关 键 词：糖尿病 2型 持续动态血糖监测 糖化血红蛋白 周围神经病变 

分 类 号：R587.1[医药卫生—内分泌]