CAJ | 학술논문

目的：探讨超敏C反映蛋白（Hs-CRP）与2型糖尿病（T2DM）患者胰岛素β细胞及如何制定降糖方案之间的关系。方法选取112例T2DM患者，根据糖化血红蛋白（HbA1c）水平分组：HbA1c＜7％组、HbAlc7％～9％组及HbAlc＞9％组，记录患者一般信息及并发症情况，检测血清Hs-CRP、空腹血糖（FBG）及HbA1c等各项指标，停用降糖治疗3 d后再次收集空腹血浆，检测空腹胰岛素水平，计算胰岛素分泌指数（ Homa IS）。分别比较3组间Hs-CRP、FBG、体重指数（ BMI）、Homa IS、腰臀水平。结果（1）HbA1c＞9％组的Hs-CRP、Homa IS较HbAlc＜7％组及HbAlc7％～9％组显著增高；（2）Homa IS与Hs-CRP、HbA1c存在负相关，吸烟患者在血糖严重未达标组比例较高；（3）以Hs-CRP的分组做应变量，将所有因子引入单因素Logistic回归分析，发现吸烟史及合并2种以上慢性病有意义，进一步行多元Logistic回归分析发现吸烟史和合并2种以上慢性病均为Hs-CRP增高的危险因素。结论（1）Hs-CRP明显升高与血糖控制不达标相关，提示需更改治疗方案，而吸烟史是影响治疗效果的因素之一；（2） Hs-CRP可反应患者胰岛素分泌指数；（3）不能仅以患者空腹胰岛素水平制定降糖方案，应联合评估患者空腹胰岛素水平、hs-CRP及Homa IS来制定治疗方案；（4）吸烟史以及T2 DM合并2种以上慢性病与Hs-CRP升高相关，提示糖尿病合并多种慢性病时血糖管理更难达标。
목적：탐토초민C반영단백（Hs-CRP）여2형당뇨병（T2DM）환자이도소β세포급여하제정강당방안지간적관계。방법선취112례T2DM환자，근거당화혈홍단백（HbA1c）수평분조：HbA1c＜7％조、HbAlc7％～9％조급HbAlc＞9％조，기록환자일반신식급병발증정황，검측혈청Hs-CRP、공복혈당（FBG）급HbA1c등각항지표，정용강당치료3 d후재차수집공복혈장，검측공복이도소수평，계산이도소분비지수（ Homa IS）。분별비교3조간Hs-CRP、FBG、체중지수（ BMI）、Homa IS、요둔수평。결과（1）HbA1c＞9％조적Hs-CRP、Homa IS교HbAlc＜7％조급HbAlc7％～9％조현저증고；（2）Homa IS여Hs-CRP、HbA1c존재부상관，흡연환자재혈당엄중미체표조비례교고；（3）이Hs-CRP적분조주응변량，장소유인자인입단인소Logistic회귀분석，발현흡연사급합병2충이상만성병유의의，진일보행다원Logistic회귀분석발현흡연사화합병2충이상만성병균위Hs-CRP증고적위험인소。결론（1）Hs-CRP명현승고여혈당공제불체표상관，제시수경개치료방안，이흡연사시영향치료효과적인소지일；（2） Hs-CRP가반응환자이도소분비지수；（3）불능부이환자공복이도소수평제정강당방안，응연합평고환자공복이도소수평、hs-CRP급Homa IS래제정치료방안；（4）흡연사이급T2 DM합병2충이상만성병여Hs-CRP승고상관，제시당뇨병합병다충만성병시혈당관리경난체표。
Objective To discuss the relationship between homeostasis model assessment -B and the glucose solution of hypersensitive 3c-reativeprotrin (hs -crp) and type 2 diabetic patient (t2dm) treatment.Methods Selecting 112 patients with type 2 diabetes. Through Hs-CRP detection of blood glucose and glycosylated hemoglobin , fasting automatic biochemical analyzer (HbA1c) and other indi-cators, they were divided into different groups: HbA1c<7%, HbAlc7%~9%, and HbAlc>9% group.The complications of patients were recorded.Hs-CRP, fasting plasma glucose( FBG ) and HbA1c were detected.Fasting insulin level was detected to measure Homa . Hs-CRP, FBG, BMI, Homa IS and hip level in different groups were compared .Results (1) HbA1c>9%, Hs-CRP and Homa IS groups increased significantly compared with HbAlc <7%and HbAlc7%~9%groups.(2)Homa IS, Hs-CRP and HbA1c had negative relationship.Smoking patients didn′t reach the proportion in blood glucose significant low level .(3)Through regarding Hs-CRP group as the dependent variable , all factors were put into a single factor Logistic regression analysis .It was found that smoking history and combined with 2 or more chronic diseases had significance .Further multivariate Logistic regression analysis showed that smoking and with more than 2 kinds of chronic diseases were risk factors of Hs -CRP.Conclusion (1)Hs-CRP significant increase is related with unsuccessful blood glucose control.This needs improvement schedule .And the smoking history is one of the influencing factors of treatment effect .(2)Hs-CRP can reflect homeostasis model assessment -B.(3) The glucose solution can not be formulated only with patients′fasting insulin, but also with Hs-CRP and Homa IS.(4) There was high correlation between smoking history and T 2DM combined with two kinds chronic diseases and Hs-CRP.This proposes that it is difficult to achieve the goal when diabetes is combined with lots of chronic diseases .