CAJ | 학술논문

目的探讨2型糖尿病患者颈动脉内膜中层厚度(CIMT)与血糖波动的相关性.方法将我院2012年3至8月收治的68例2型糖尿病患者,根据颈动脉超声结果分为两组,CIMT增厚组36例(CIMT≥0.9 mm)和CIMT正常组32例(CIMT ＜0.9 mm),在人院当天行72 h动态血糖监测,并检测相关生化指标.结果 ①两组间性别、年龄、BMI、血压、HDL-C、LDL-C、TC、TG、糖化血红蛋白、空腹血糖、餐后2h平均血糖比较,差异均无统计学意义(P＞0.05)；②CIMT增厚组病程、平均血糖波动幅度、平均血糖标准差、血糖波动频数、日问血糖波动幅度、动脉粥样硬化积分分别为(11.5±7.3)年、(6.9 ±3.0) mmol/L、(2.8±1.2) mmol/L、(3.4±1.5)次/d、(2.8±1.3) mmol/L和(4.5±1.0)分,CIMT正常组分别为(8±6)年、(4.2±1.1)mmol/L、(1.6±0.5)mmol/L、(2.2±0.8)次/d、(2.0±1.0) mmol/L和(3.3±0.6)分,两组比较差异均有统计学意义(t值分别为0.31、0.53、0.22、0.35、0.37、0.44,均P＜0.05)；③CIMT与平均血糖波动幅度、血糖波动频数、日问血糖波动幅度、病程、舒张压、LDL-C、餐后2h平均血糖、动脉粥样硬化积分均呈正相关(r值为0.30 ～ 0.53,均P＜0.05)；④CIMT与平均血糖波动幅度、餐后2h平均血糖显著相关,以CIMT为因变量,各相关因素为自变量,只有平均血糖波动幅度、餐后2h平均血糖最终进入回归方程.结论 2型糖尿病患者的CIMT水平与血糖波动密切相关,减少血糖波动、降低平均血糖波动幅度和餐后2h平均血糖水平可能有延缓糖尿病大血管病变的作用.
목적 탐토2형당뇨병환자경동맥내막중층후도(CIMT)여혈당파동적상관성.방법 장아원2012년3지8월수치적68례2형당뇨병환자,근거경동맥초성결과분위량조,CIMT증후조36례(CIMT≥0.9 mm)화CIMT정상조32례(CIMT ＜0.9 mm),재인원당천행72 h동태혈당감측,병검측상관생화지표.결과 ①량조간성별、년령、BMI、혈압、HDL-C、LDL-C、TC、TG、당화혈홍단백、공복혈당、찬후2h평균혈당비교,차이균무통계학의의(P＞0.05)；②CIMT증후조병정、평균혈당파동폭도、평균혈당표준차、혈당파동빈수、일문혈당파동폭도、동맥죽양경화적분분별위(11.5±7.3)년、(6.9 ±3.0) mmol/L、(2.8±1.2) mmol/L、(3.4±1.5)차/d、(2.8±1.3) mmol/L화(4.5±1.0)분,CIMT정상조분별위(8±6)년、(4.2±1.1)mmol/L、(1.6±0.5)mmol/L、(2.2±0.8)차/d、(2.0±1.0) mmol/L화(3.3±0.6)분,량조비교차이균유통계학의의(t치분별위0.31、0.53、0.22、0.35、0.37、0.44,균P＜0.05)；③CIMT여평균혈당파동폭도、혈당파동빈수、일문혈당파동폭도、병정、서장압、LDL-C、찬후2h평균혈당、동맥죽양경화적분균정정상관(r치위0.30 ～ 0.53,균P＜0.05)；④CIMT여평균혈당파동폭도、찬후2h평균혈당현저상관,이CIMT위인변량,각상관인소위자변량,지유평균혈당파동폭도、찬후2h평균혈당최종진입회귀방정.결론 2형당뇨병환자적CIMT수평여혈당파동밀절상관,감소혈당파동、강저평균혈당파동폭도화찬후2h평균혈당수평가능유연완당뇨병대혈관병변적작용.
Objective To investigate the correlation between carotid intima-media thickness (CIMT) and glucose fluctuation in patients with type 2 diabetes mellitus (T2DM).Methods Sixty-eight T2DM patients admitted to Beijing Military General Hospital from March to August 2012 were enrolled in the study,including 32 cases with CIMT thickening (CIMT ≥ 0.9 mm) and 32 cases with normal CIMT (CIMT ＜0.9 mm).The 72 h continuous blood glucose levels were monitored from the day of admission.Results There were no significant differences in the gender,age,body mass index (BMI),systolic and diastolic blood pressure,HDL-C,LDL-C,CHO,TG,glycosylate hemoglobin (HbA1c),fasting blood glucose(FBG) and postprandial average blood glucose (MPBG) between two groups (P ＞ 0.05).The atherosclerosis (AS) score and mean amplitude of glycemic excursion (MAGE),glucose standard deviation,frequency of glycemic excursion (FGE) and absolute mean of daily differences (MODD) in patients with thickening CIMT were (11 ± 7) years,(6.9 ± 3.0) mmol/L,(2.8 ± 1.2) mmol/L,(3.4 ± 1.5) times/d,(2.8 ± 1.3) mmol/L,(4.5 ± 1.0) score,respectively ; while those in patients with normal CIMT were (8 ±6) years,(4.2 ± 1.1) mmol/L,(1.6 ± 0.5) mmol/L,(2.2 ± 0.8) times/d,(2.0 ± 1.0) mmol/L,(3.3 ±0.6) score,respectively.There were significant differences between two groups (all P ＜ 0.05).Pearson correlation showed that CIMT was positively correlated with MAGE,FGE,MODD,course of disease,diastolic blood pressure,LDL-C,MPBG and AS score (P ＜ 0.05).Multiple stepwise regression analysis showed that MAGE,MBPG were the influencing factors of CIMT.Conclusions The CIMT of patients with T2DM is closely correlated with glucose fluctuation,indicating that reduction of blood glucose fluctuation and MAGE,MPBG levels may delay the occurrence of diabetic macroangiopathy.