CAJ | 학술논문

目的：探讨血糖波动对2型糖尿病(T2DM)合并下肢血管病变患者血管内皮功能(FMD)的影响,并对相关危险因素进行分析。方法选择2013年3月-2014年4月在北京军区总医院内分泌科住院治疗且符合纳入标准的T2DM患者49例,按照超声检测是否合并下肢血管病变分为 T2DM 合并下肢血管病变组( A组)29例、单纯T2DM组(B组)20例。对两组分别行72 h动态血糖监测,测得动态血糖参数：日内平均血糖波动幅度(MAGE),最大血糖波动幅度( LAGE),全天血糖标准差( SDBG),日间血糖平均绝对差( MODD),平均餐后血糖波动幅度( MPPGE)。同时检测两组肱动脉血压、FMD及血脂、同型半胱氨酸( Hcy)、丙二醛( MDA)、糖化血红蛋白( HbA1c)等临床生化指标,比较两组间各指标的差异。对FMD与各观察指标进行相关分析。结果①A组收缩压( SBP)、TC、TG、低密度脂蛋白胆固醇(LDL-C)、HbA1c、Hcy、MDA显著高于B组(P<0.05),FMD较B组明显降低(P<0.05)。②A组MAGE、LAGE、SDBG、MODD、MPPGE显著高于 B 组(P <0.05)。③FMD 与 SBP、LDL-C、HbA1c、Hcy、MDA、TC、TG、MAGE、SDBG、MODD、MPPGE呈显著负相关( r=-0.355,-0.272,-0.337,-0.345,-0.320,-0.345,-0.302,-0.418,-0.475,-0.312,-0.387,-0.313,P<0.05,P<0.01)。④多元逐步回归分析结果：MODD、Hcy、TC是影响FMD的独立危险因素(Y=8.390-0.117Hcy-0.316TC-0.495MODD)。结论血糖波动与T2DM下肢血管病变患者FMD关系密切。 Hcy与血糖波动相关,可能通过氧化应激作用参与对FMD的损害。
목적：탐토혈당파동대2형당뇨병(T2DM)합병하지혈관병변환자혈관내피공능(FMD)적영향,병대상관위험인소진행분석。방법선택2013년3월-2014년4월재북경군구총의원내분비과주원치료차부합납입표준적T2DM환자49례,안조초성검측시부합병하지혈관병변분위 T2DM 합병하지혈관병변조( A조)29례、단순T2DM조(B조)20례。대량조분별행72 h동태혈당감측,측득동태혈당삼수：일내평균혈당파동폭도(MAGE),최대혈당파동폭도( LAGE),전천혈당표준차( SDBG),일간혈당평균절대차( MODD),평균찬후혈당파동폭도( MPPGE)。동시검측량조굉동맥혈압、FMD급혈지、동형반광안산( Hcy)、병이철( MDA)、당화혈홍단백( HbA1c)등림상생화지표,비교량조간각지표적차이。대FMD여각관찰지표진행상관분석。결과①A조수축압( SBP)、TC、TG、저밀도지단백담고순(LDL-C)、HbA1c、Hcy、MDA현저고우B조(P<0.05),FMD교B조명현강저(P<0.05)。②A조MAGE、LAGE、SDBG、MODD、MPPGE현저고우 B 조(P <0.05)。③FMD 여 SBP、LDL-C、HbA1c、Hcy、MDA、TC、TG、MAGE、SDBG、MODD、MPPGE정현저부상관( r=-0.355,-0.272,-0.337,-0.345,-0.320,-0.345,-0.302,-0.418,-0.475,-0.312,-0.387,-0.313,P<0.05,P<0.01)。④다원축보회귀분석결과：MODD、Hcy、TC시영향FMD적독립위험인소(Y=8.390-0.117Hcy-0.316TC-0.495MODD)。결론혈당파동여T2DM하지혈관병변환자FMD관계밀절。 Hcy여혈당파동상관,가능통과양화응격작용삼여대FMD적손해。
Objective To investigate the influence of blood glucose fluctuation on endothelia-dependent flow-mediated dilatation (FMD) patients with type 2 diabetes mellitus (T2DM) complicated with lower extremity vascular le-sion and to analyze the related risk factors. Methods A total of 49 patients with T2DM during March 2013 and April 2014 were enrolled in the study. According to the occurrence of lower extremity atherosclerosis by color Doppler ultra-sound, the patients were divided into T2DM patients with lower extremity vascular disease (group A, n=29) and pa-tients with T2DM (group B, n=20). The 72 h continuous glucose monitoring were performed respectively for the two groups to detect the glucose parameters, such as mean amplitude of glycemic excursions ( MAGE) , largest amplitude of glycemic excursions ( LAGE) , standard deviation of blood glucose ( SDBG) of one day, absolute means of daily differ-ence ( MODD) and mean postprandial glucose excursion ( MPPGE) , and the values of brachial artery blood pressure, FMD, blood fat, homocysteine (Hcy), malondialdehyde (MDA) and glycosylated hemoglobin (HbA1c) which were de-tected at the same time, and then the difference of each index in two groups was compared respectively. The correlation between FMD with the indexes was analyzed. Results ① The levels of systolic blood pressure (SBP), TG, TC low density lipoprotein cholesterol (LDL-C), HbA1c, Hcy and MDA in group A were significantly higher than those in group B (P<0. 05), while the FMD value was significantly lower than that in group B (P<0. 05); ②the levels of MAGE, LAGE, SDBG, MODD and MPPGE in group A were significantly higher than those in group B (P<0. 05). ③The FMD value had significantly negative relationship with values of SBP, LDL-C, HbA1c, Hcy, MDA, TC, TG, MAGE, SDBG, MODD and MPPGE (r= -0. 355, -0. 272, -0. 337, -0. 345, -0. 320, -0. 345, -0. 302, -0. 418, -0. 475,-0. 312, -0. 387, -0. 313;P<0. 05, P<0. 01). ④The multiple stepwise regression analysis showed that MODD, Hcy and TC were independent influencing risk factors of FMD(Y=8. 390 -0. 117Hcy -0. 316TC -0. 495MODD). Conclusion Blood sugar fluctuation in T2DM patients with lower extremity vascular disease is closely related with FMD. Hcy is related to blood sugar fluctuation, which may damage the FMD under oxidative stress.