目的 探讨2型糖尿病患者血糖波动与血管并发症的关系,并对其相关因素进行分析.方法 选取2005年9月至2011年3月在武汉大学中南医院内分泌科住院的2型糖尿病患者712例为研究对象,入院后进行全面的糖尿病并发症评估,所有患者均空腹测量身高、体重,计算体质指数,测量血压,检测糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白a(Lpa)、超敏C反应蛋白(hs CRP)、总胆固醇(TC)、甘油三酯(TG)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿素氮(BUN)、肌酐(Cr)和静脉血糖,并监测至少2次完整的7段血糖,计算胰岛细胞β功能指数(HOMA-β)、校正的胰岛素增量反应(CIR)、胰岛素生成指数(IGI)、胰岛素曲线下面积(AUCINS).日内血糖波动用标准差(SD)进行评估,根据SD四分位数将患者分为4组(Q1 sd～Q4 sd)；日间血糖波动用通过7段血糖曲线下面积计算岀的平均血糖变异系数(MBS-CV)进行评估.根据MBS-CV四分位数将患者分为4组(Q1 mc～Q4 mc).分析及比较不同的日内及日间血糖波动水平组中各项指标的差异.计量资料采用独立样本t检验或方差分析,计数资料采用x2检验,二分类变量应用logistic回归分析探讨血管并发症的相关危险因素.结果 (1)Q1 sd～Q4 sd组患者的病程(4组平均为4 5、6.1、6.7、6.8年,F=4.683,P＜0.05)、糖化血红蛋白(HbA1c)水平(4组HbA1c平均值分别为8.7％、9.2％、8.9％及9.9％,F=5.043,P＜0.05)和胰岛β细胞功能(4组HOMA-β平均为2.1、7.4、5.2和1.5,F =3.462,P＜0.05)、CIR(4组CIR平均为4.2、5.0、3.1和1.2,F=5.308,P ＜0.05)、IGI(4组IGI平均为2.3、0.8、0.6和1.0,F=2.963,P＜0.05)、AUCINS(4组AUCINS平均为101.2、86.9、72.0和47.1,F=2.835,P ＜0.05)差异均有统计学意义；Q1 mc～Q4 mc组患者的血糖水平(4组HbA1c平均值分别为8.1％、8.9％、9.3％和10.9％,F=23.669,P ＜0.001)和胰岛β细胞功能(4组HOMA-β平均值分别为1.4、1.6、2.2和2.4,F=4.884,P＜0.05;4组CIR 平均值分别为3.3、3.4、4.4和1.1,F=8.083,P ＜0.05；4组TGI平均值分别为2.1、2.4、0.3和0.2,F=5.433,P ＜0.05;4组AUCINS平均值分别为103.3、92.7、68.8和56.6,F =4.148,P＜0.05)差异有统计学意义.(2)随着日内血糖波动幅度和日间血糖波动幅度的增加,各种糖尿病并发症的发生率呈上升趋势,然而慢性并发症的发生率在不同日内血糖波动组之间(x2 =4.115,P＞0.05)及不同日间血糖波动组之间(x2=2.365,P＞0.05)差异均无统计学意义.患有1种或2种以上并发症的患者比例在日内和日间血糖波动幅度较大组均明显升高,慢性并发症的种类在不同日内血糖波动组之间(x2=12.286,P ＞0.05)及不同日间血糖波动组之间(x2=10.543,P ＞0.05)均无统计学差异.(3)回归分析显示,日内血糖波动指数(B=3.453,P＜0.05)是糖尿病视网膜病变的相关因素,日间血糖波动指数(B=2.546,P＜0.05)是大血管病变的相关因素.结论 血糖波动可能与血糖控制、病程、胰岛β细胞功能和胰岛素抵抗相关,随着血糖波动幅度的增大,血管并发症的发生风险和种类可能也会增加.血糖波动可能与糖尿病视网膜病变和大血管病变相关.
目的 探討2型糖尿病患者血糖波動與血管併髮癥的關繫,併對其相關因素進行分析.方法 選取2005年9月至2011年3月在武漢大學中南醫院內分泌科住院的2型糖尿病患者712例為研究對象,入院後進行全麵的糖尿病併髮癥評估,所有患者均空腹測量身高、體重,計算體質指數,測量血壓,檢測糖化血紅蛋白(HbA1c)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、載脂蛋白A1(ApoA1)、載脂蛋白B(ApoB)、脂蛋白a(Lpa)、超敏C反應蛋白(hs CRP)、總膽固醇(TC)、甘油三酯(TG)、丙氨痠轉氨酶(ALT)、天鼕氨痠轉氨酶(AST)、尿素氮(BUN)、肌酐(Cr)和靜脈血糖,併鑑測至少2次完整的7段血糖,計算胰島細胞β功能指數(HOMA-β)、校正的胰島素增量反應(CIR)、胰島素生成指數(IGI)、胰島素麯線下麵積(AUCINS).日內血糖波動用標準差(SD)進行評估,根據SD四分位數將患者分為4組(Q1 sd～Q4 sd)；日間血糖波動用通過7段血糖麯線下麵積計算岀的平均血糖變異繫數(MBS-CV)進行評估.根據MBS-CV四分位數將患者分為4組(Q1 mc～Q4 mc).分析及比較不同的日內及日間血糖波動水平組中各項指標的差異.計量資料採用獨立樣本t檢驗或方差分析,計數資料採用x2檢驗,二分類變量應用logistic迴歸分析探討血管併髮癥的相關危險因素.結果 (1)Q1 sd～Q4 sd組患者的病程(4組平均為4 5、6.1、6.7、6.8年,F=4.683,P＜0.05)、糖化血紅蛋白(HbA1c)水平(4組HbA1c平均值分彆為8.7％、9.2％、8.9％及9.9％,F=5.043,P＜0.05)和胰島β細胞功能(4組HOMA-β平均為2.1、7.4、5.2和1.5,F =3.462,P＜0.05)、CIR(4組CIR平均為4.2、5.0、3.1和1.2,F=5.308,P ＜0.05)、IGI(4組IGI平均為2.3、0.8、0.6和1.0,F=2.963,P＜0.05)、AUCINS(4組AUCINS平均為101.2、86.9、72.0和47.1,F=2.835,P ＜0.05)差異均有統計學意義；Q1 mc～Q4 mc組患者的血糖水平(4組HbA1c平均值分彆為8.1％、8.9％、9.3％和10.9％,F=23.669,P ＜0.001)和胰島β細胞功能(4組HOMA-β平均值分彆為1.4、1.6、2.2和2.4,F=4.884,P＜0.05;4組CIR 平均值分彆為3.3、3.4、4.4和1.1,F=8.083,P ＜0.05；4組TGI平均值分彆為2.1、2.4、0.3和0.2,F=5.433,P ＜0.05;4組AUCINS平均值分彆為103.3、92.7、68.8和56.6,F =4.148,P＜0.05)差異有統計學意義.(2)隨著日內血糖波動幅度和日間血糖波動幅度的增加,各種糖尿病併髮癥的髮生率呈上升趨勢,然而慢性併髮癥的髮生率在不同日內血糖波動組之間(x2 =4.115,P＞0.05)及不同日間血糖波動組之間(x2=2.365,P＞0.05)差異均無統計學意義.患有1種或2種以上併髮癥的患者比例在日內和日間血糖波動幅度較大組均明顯升高,慢性併髮癥的種類在不同日內血糖波動組之間(x2=12.286,P ＞0.05)及不同日間血糖波動組之間(x2=10.543,P ＞0.05)均無統計學差異.(3)迴歸分析顯示,日內血糖波動指數(B=3.453,P＜0.05)是糖尿病視網膜病變的相關因素,日間血糖波動指數(B=2.546,P＜0.05)是大血管病變的相關因素.結論 血糖波動可能與血糖控製、病程、胰島β細胞功能和胰島素牴抗相關,隨著血糖波動幅度的增大,血管併髮癥的髮生風險和種類可能也會增加.血糖波動可能與糖尿病視網膜病變和大血管病變相關.
목적 탐토2형당뇨병환자혈당파동여혈관병발증적관계,병대기상관인소진행분석.방법 선취2005년9월지2011년3월재무한대학중남의원내분비과주원적2형당뇨병환자712례위연구대상,입원후진행전면적당뇨병병발증평고,소유환자균공복측량신고、체중,계산체질지수,측량혈압,검측당화혈홍단백(HbA1c)、저밀도지단백담고순(LDL-C)、고밀도지단백담고순(HDL-C)、재지단백A1(ApoA1)、재지단백B(ApoB)、지단백a(Lpa)、초민C반응단백(hs CRP)、총담고순(TC)、감유삼지(TG)、병안산전안매(ALT)、천동안산전안매(AST)、뇨소담(BUN)、기항(Cr)화정맥혈당,병감측지소2차완정적7단혈당,계산이도세포β공능지수(HOMA-β)、교정적이도소증량반응(CIR)、이도소생성지수(IGI)、이도소곡선하면적(AUCINS).일내혈당파동용표준차(SD)진행평고,근거SD사분위수장환자분위4조(Q1 sd～Q4 sd)；일간혈당파동용통과7단혈당곡선하면적계산출적평균혈당변이계수(MBS-CV)진행평고.근거MBS-CV사분위수장환자분위4조(Q1 mc～Q4 mc).분석급비교불동적일내급일간혈당파동수평조중각항지표적차이.계량자료채용독립양본t검험혹방차분석,계수자료채용x2검험,이분류변량응용logistic회귀분석탐토혈관병발증적상관위험인소.결과 (1)Q1 sd～Q4 sd조환자적병정(4조평균위4 5、6.1、6.7、6.8년,F=4.683,P＜0.05)、당화혈홍단백(HbA1c)수평(4조HbA1c평균치분별위8.7％、9.2％、8.9％급9.9％,F=5.043,P＜0.05)화이도β세포공능(4조HOMA-β평균위2.1、7.4、5.2화1.5,F =3.462,P＜0.05)、CIR(4조CIR평균위4.2、5.0、3.1화1.2,F=5.308,P ＜0.05)、IGI(4조IGI평균위2.3、0.8、0.6화1.0,F=2.963,P＜0.05)、AUCINS(4조AUCINS평균위101.2、86.9、72.0화47.1,F=2.835,P ＜0.05)차이균유통계학의의；Q1 mc～Q4 mc조환자적혈당수평(4조HbA1c평균치분별위8.1％、8.9％、9.3％화10.9％,F=23.669,P ＜0.001)화이도β세포공능(4조HOMA-β평균치분별위1.4、1.6、2.2화2.4,F=4.884,P＜0.05;4조CIR 평균치분별위3.3、3.4、4.4화1.1,F=8.083,P ＜0.05；4조TGI평균치분별위2.1、2.4、0.3화0.2,F=5.433,P ＜0.05;4조AUCINS평균치분별위103.3、92.7、68.8화56.6,F =4.148,P＜0.05)차이유통계학의의.(2)수착일내혈당파동폭도화일간혈당파동폭도적증가,각충당뇨병병발증적발생솔정상승추세,연이만성병발증적발생솔재불동일내혈당파동조지간(x2 =4.115,P＞0.05)급불동일간혈당파동조지간(x2=2.365,P＞0.05)차이균무통계학의의.환유1충혹2충이상병발증적환자비례재일내화일간혈당파동폭도교대조균명현승고,만성병발증적충류재불동일내혈당파동조지간(x2=12.286,P ＞0.05)급불동일간혈당파동조지간(x2=10.543,P ＞0.05)균무통계학차이.(3)회귀분석현시,일내혈당파동지수(B=3.453,P＜0.05)시당뇨병시망막병변적상관인소,일간혈당파동지수(B=2.546,P＜0.05)시대혈관병변적상관인소.결론 혈당파동가능여혈당공제、병정、이도β세포공능화이도소저항상관,수착혈당파동폭도적증대,혈관병발증적발생풍험화충류가능야회증가.혈당파동가능여당뇨병시망막병변화대혈관병변상관.
Objective To explore the relationship between glucose variability and vascular complications in type 2 diabetic patients,and analysis the related factors.Methods Data were obtained from 712 type 2 diabetic patients hospitalized in the Endocrinology department from Sep 2005 to Mar 2011,and with full evaluation of diabetic complications,β cell function detection,liver and kidney function,lipid profile and at least two complete 7-point blood glucose profile.Within-day blood glucose fluctuation was evaluated by standard deviation (SD),and patients were separated into four groups according to the SD quartiles(Q1 sd-Q4 sd).Day-to-day blood glucose fluctuation was evaluated by MBS-coeffecient of variance (CV),and patients were separated into four groups according to MBS-CV quartiles(Q1 mc-Q4 mc)Further analyze the comparisons of variant indexes among different within-day and day-to-day blood glucose fluctuation groups.Quantitative data were use independent t test or ANOVA analysis.Count data were use x2 analysis.Binary variables were use binary logistic regression analysis to evaluate the related risk factors for vascular complications.Results (1) Patients in Q1 sd-Q4 sd groups have significant in the course of disease(average in four groups were 4.5,6.1,6.7 and 6.8 years.F =4.683,P ＜ 0.05),blood glucose control(average HbA1c in four groups were 8.7％,9.2％,8.9％ and 9.9％,F =5.043,P ＜0.05) and the β cell function(average HOMA-β in four groups were 2.1,7.4,5.2,and 1.5,F =3.462,P ＜ 0.05 ;average CIR in four groups were 4.2,5.0,3.1 and 1.2,F =5.308,P ＜ 0.05 ;average IGI in four groups were 2.3,0.8,0.6 and 1.0,F =2.963,P ＜ 0.05 ; average AUCINS in four groups were 101.2,86.9,72.0 and 47.1,F =2.835,P ＜ 0.05).Patients in Q1 mc-Q4 mc groups have significant in the blood glucose control (Average HbA1c in four groups were 8.1％,8.9％,9.3％ and 10.9％,F =23.669,P＜0.05) and the β cell fuuction(average HOMA-β in four groups were 1.4,1.6,2.2 and 2.4,F =4.884,P =0.05 ; average CIR in four groups were 3.3,3.4,4.4 and 1.1,F =8.083,P ＜ 0.05 ; average IGI in four groups were 2.1,2.4,0.3 and 0.2,F =5.433,P ＜ 0.05 ; average AUCINS in four groups were 103.3,92.7,68.8 and 56.6,F =4.148,P ＜ 0.05).(2) The incidence of diabetic complications were increased with the increase of within-day blood glucose fluctuation and day-to-day blood glucose fluctuation.But analysis shown no significant difference among Q1 sd-Q4 sd groups (x2 =4.115,P＞ 0.05) and Q1 mc-Q4 mc groups (x2 =2.365,P ＞ 0.05).Proportions of patients with 1 or over 2 kinds of diabetic complications were increased with the increase of within-day blood glucose fluctuation and day-to-day blood glucose fluctuation.But analysis shown no significant difference among Q1 sd-Q4 sd groups (x2 =12.286,P ＞ 0.05) and Q1 mc-Q4 mc groups (x2 =10.543,P ＞0.05).(3) Regression analysis shows that SD is the related factor for diabetic retinopathy (P ＜ 0.05),MBS-CV is the related factor for macrovascular complications (P＜0.05).Conclusion Glucose variability is probably related with blood control,course of disease,β cell function and insulin resistance.The risk and categories of diabetic complications might increased with the increase of glucose variability.Glucose variability might by related to the process of diabetic retinopathy and macrovascular complications.
