目的 观察糖化血红蛋白(HbA1c) ＜7.0％的2型糖尿病患者血糖波动与糖尿病微血管病变(视网膜病变、糖尿病肾病)及血清血管内皮生长因子(VEGF)、血小板源性生长因子-BB(PDGF-BB)水平之间的关系,探讨其在HbA1c达标患者中的相互影响机制.方法 选取2010年10月至2012年8月在黑龙江省医院内分泌科就诊的2型糖尿病患者100例,其中男52例、女48例,年龄40 ～66岁.根据是否合并糖尿病微血管病变分为单纯2型糖尿病组[A组,n=30,男14例,女16例,年龄(50±11)岁],糖尿病肾病组[B组,n=38,男20例,女18例,年龄(52±10)岁]和糖尿病视网膜病变组[C组,n=32,男18例,女14例,年龄(53±13)岁].另以同期于黑龙江省医院进行体检的25名健康者为正常对照组[Con组,n=25,男12例,女13例,年龄(48±9)岁].人院前糖尿病患者均使用药物治疗.所有参试者均测定空腹血糖浓度(FPG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、餐后2h血糖浓度(2 h PG)、24 h尿微量白蛋白(24 h尿ALB)和HbA1c.应用动态血糖监测系统连续监测血糖3d,计算平均血糖(MBG)、平均血糖标准差(SDBG)、平均血糖波动幅度(MAGE)、日内最大血糖波动幅度(LAGE)、日间血糖平均绝对差(MODD)和曲线下面积(AUC).采用酶联免疫吸附法分别检测血清中VEGF和PDGF-BB水平.计量资料组间比较采用t检验,多组间比较采用单因素方差分析,糖尿病微血管并发症的影响因素采用logistic回归分析,PDGF-BB、VEGF相关因素采用多元线性回归分析.结果 (1)B组PDGF-BB水平高于A组和Con组[分别为(53±12)、(31±6)、(26±4)μg/ml,F=9.56,P＜0.05]；C组VEGF水平高于A组和Con组[分别为(217±57)、(105±12)、(74±10) μg/ml,F=8.13,P＜0.05].(2)动态血糖监测指标B组与A组比较,SDBG、LAGF、MAGE、MODD、AUC明显升高(t=2.57、3.46、5.75、3.59、4.28,均P＜0.05),C组与A组比较,SDBG、LAGF、MAGE、MODD、AUC明显升高(t=3.29、3.77、5.38、4.54、3.16,均P＜0.05),而MBG在3组间的差异无统计学意义,均P＞0.05.(3)logistic回归分析显示PDGF-BB、VEGF及血糖波动是糖尿病微血管并发症独立危险因素.分别以PDGF-BB、VEGF为因变量,以血糖波动指标SDBG、LAGF、MAGE、MODD、AUC及2 hPG为自变量,采用多元线性回归分析可能影响PDGF-BB、VEGF的相关因素,结果显示,MAGE、SDBG和2 hPG对PDGF-BB、VEGF影响最大.结论 2型糖尿病患者微血管病变的发生发展与血糖波动具有明显相关性,血糖波动可导致血清血管内皮生长因子和血小板源性生长因子-BB水平增高,从而参与糖尿病视网膜病变、糖尿病肾病等微血管病变的进展.
目的 觀察糖化血紅蛋白(HbA1c) ＜7.0％的2型糖尿病患者血糖波動與糖尿病微血管病變(視網膜病變、糖尿病腎病)及血清血管內皮生長因子(VEGF)、血小闆源性生長因子-BB(PDGF-BB)水平之間的關繫,探討其在HbA1c達標患者中的相互影響機製.方法 選取2010年10月至2012年8月在黑龍江省醫院內分泌科就診的2型糖尿病患者100例,其中男52例、女48例,年齡40 ～66歲.根據是否閤併糖尿病微血管病變分為單純2型糖尿病組[A組,n=30,男14例,女16例,年齡(50±11)歲],糖尿病腎病組[B組,n=38,男20例,女18例,年齡(52±10)歲]和糖尿病視網膜病變組[C組,n=32,男18例,女14例,年齡(53±13)歲].另以同期于黑龍江省醫院進行體檢的25名健康者為正常對照組[Con組,n=25,男12例,女13例,年齡(48±9)歲].人院前糖尿病患者均使用藥物治療.所有參試者均測定空腹血糖濃度(FPG)、總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、餐後2h血糖濃度(2 h PG)、24 h尿微量白蛋白(24 h尿ALB)和HbA1c.應用動態血糖鑑測繫統連續鑑測血糖3d,計算平均血糖(MBG)、平均血糖標準差(SDBG)、平均血糖波動幅度(MAGE)、日內最大血糖波動幅度(LAGE)、日間血糖平均絕對差(MODD)和麯線下麵積(AUC).採用酶聯免疫吸附法分彆檢測血清中VEGF和PDGF-BB水平.計量資料組間比較採用t檢驗,多組間比較採用單因素方差分析,糖尿病微血管併髮癥的影響因素採用logistic迴歸分析,PDGF-BB、VEGF相關因素採用多元線性迴歸分析.結果 (1)B組PDGF-BB水平高于A組和Con組[分彆為(53±12)、(31±6)、(26±4)μg/ml,F=9.56,P＜0.05]；C組VEGF水平高于A組和Con組[分彆為(217±57)、(105±12)、(74±10) μg/ml,F=8.13,P＜0.05].(2)動態血糖鑑測指標B組與A組比較,SDBG、LAGF、MAGE、MODD、AUC明顯升高(t=2.57、3.46、5.75、3.59、4.28,均P＜0.05),C組與A組比較,SDBG、LAGF、MAGE、MODD、AUC明顯升高(t=3.29、3.77、5.38、4.54、3.16,均P＜0.05),而MBG在3組間的差異無統計學意義,均P＞0.05.(3)logistic迴歸分析顯示PDGF-BB、VEGF及血糖波動是糖尿病微血管併髮癥獨立危險因素.分彆以PDGF-BB、VEGF為因變量,以血糖波動指標SDBG、LAGF、MAGE、MODD、AUC及2 hPG為自變量,採用多元線性迴歸分析可能影響PDGF-BB、VEGF的相關因素,結果顯示,MAGE、SDBG和2 hPG對PDGF-BB、VEGF影響最大.結論 2型糖尿病患者微血管病變的髮生髮展與血糖波動具有明顯相關性,血糖波動可導緻血清血管內皮生長因子和血小闆源性生長因子-BB水平增高,從而參與糖尿病視網膜病變、糖尿病腎病等微血管病變的進展.
목적 관찰당화혈홍단백(HbA1c) ＜7.0％적2형당뇨병환자혈당파동여당뇨병미혈관병변(시망막병변、당뇨병신병)급혈청혈관내피생장인자(VEGF)、혈소판원성생장인자-BB(PDGF-BB)수평지간적관계,탐토기재HbA1c체표환자중적상호영향궤제.방법 선취2010년10월지2012년8월재흑룡강성의원내분비과취진적2형당뇨병환자100례,기중남52례、녀48례,년령40 ～66세.근거시부합병당뇨병미혈관병변분위단순2형당뇨병조[A조,n=30,남14례,녀16례,년령(50±11)세],당뇨병신병조[B조,n=38,남20례,녀18례,년령(52±10)세]화당뇨병시망막병변조[C조,n=32,남18례,녀14례,년령(53±13)세].령이동기우흑룡강성의원진행체검적25명건강자위정상대조조[Con조,n=25,남12례,녀13례,년령(48±9)세].인원전당뇨병환자균사용약물치료.소유삼시자균측정공복혈당농도(FPG)、총담고순(TC)、감유삼지(TG)、저밀도지단백담고순(LDL-C)、고밀도지단백담고순(HDL-C)、찬후2h혈당농도(2 h PG)、24 h뇨미량백단백(24 h뇨ALB)화HbA1c.응용동태혈당감측계통련속감측혈당3d,계산평균혈당(MBG)、평균혈당표준차(SDBG)、평균혈당파동폭도(MAGE)、일내최대혈당파동폭도(LAGE)、일간혈당평균절대차(MODD)화곡선하면적(AUC).채용매련면역흡부법분별검측혈청중VEGF화PDGF-BB수평.계량자료조간비교채용t검험,다조간비교채용단인소방차분석,당뇨병미혈관병발증적영향인소채용logistic회귀분석,PDGF-BB、VEGF상관인소채용다원선성회귀분석.결과 (1)B조PDGF-BB수평고우A조화Con조[분별위(53±12)、(31±6)、(26±4)μg/ml,F=9.56,P＜0.05]；C조VEGF수평고우A조화Con조[분별위(217±57)、(105±12)、(74±10) μg/ml,F=8.13,P＜0.05].(2)동태혈당감측지표B조여A조비교,SDBG、LAGF、MAGE、MODD、AUC명현승고(t=2.57、3.46、5.75、3.59、4.28,균P＜0.05),C조여A조비교,SDBG、LAGF、MAGE、MODD、AUC명현승고(t=3.29、3.77、5.38、4.54、3.16,균P＜0.05),이MBG재3조간적차이무통계학의의,균P＞0.05.(3)logistic회귀분석현시PDGF-BB、VEGF급혈당파동시당뇨병미혈관병발증독립위험인소.분별이PDGF-BB、VEGF위인변량,이혈당파동지표SDBG、LAGF、MAGE、MODD、AUC급2 hPG위자변량,채용다원선성회귀분석가능영향PDGF-BB、VEGF적상관인소,결과현시,MAGE、SDBG화2 hPG대PDGF-BB、VEGF영향최대.결론 2형당뇨병환자미혈관병변적발생발전여혈당파동구유명현상관성,혈당파동가도치혈청혈관내피생장인자화혈소판원성생장인자-BB수평증고,종이삼여당뇨병시망막병변、당뇨병신병등미혈관병변적진전.
Objective To evaluate whether the level of serum vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF-BB)correlates with the glucose fluctuation and microangiopathy,and to explore the mechanism of interaction in type 2 diabetic patients with normal glycosylated hemoglobin values.Methods A total of 100 type 2 diabetic patients with HbAlc less than 7％treated in the Heilongjiang Province Hospital were enrolled in the study with 52 males and 48 famales,aged 40-66 years old.According to the existing diabetic microangiopathy,the subjects were divided into the following three groups:the T2DM group without documented microangiopathy (n =30,14 males and 16females,aged (50 ± 11) years old) ; the diabetic nephropathy (DN) group (n =38,20 males and 18females,aged (52 ± 10) years old);the diabetic retinopathy (DR) group (n =32,18 males and 14females,aged (53 ± 13) years old).The healthy control group consisted of 25 subjects with 12 males and 13 famales aged (48 ± 9) years old,who carried out routine health examination in the same hospital during the same enrollment period.All the patients went through the laboratory examination and the following parameters were taken:fasting plasma glucose (FPG),total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein (HDL-C),2 h postprandial plasma glucose (2 h PG),24 h urine albumin (24 h urine ALB) and glycosylated hemoglobin (HbA1c).The continuous glucose monitoring system was used to detect mean blood glucose (MBG),standard deviation of mean blood glucose (SDBG),mean amplitude of glucose excursions (MAGE),largest amplitude of glucose excursions (LAGE),absolute means of daily differences (MODD) and area under curve (AUC).The level of serum VEGF and PDGF-BB were measured by the enzyme-linked immunosorbent assay (ELISA).SPSS 19.0 was used for the statistical analysis with the data shown as (x ± s).The t test,was used to compare difference between the groups and the single factor analysis of variance was used to investigate the correlation among the groups.The logistic regression analysis was used to explore the correlation factors for the diabetic microvascular complications,while the multiple linear regression analysis was adopted to investigate the correlation factors for the level of VEGF and PDGF-BB,Statistical difference was accepted at P ＜ 0.05.Results The level of PDGF-BB was significantly increased in the DN group than that of the T2DM group without documented microangiopathy and the normal control group ((53 ± 12),(31 ±6),(26 ±4) μg/ml,respectively with F =9.56 and P ＜ 0.05).The level of VEGF was significantly increased in the DR group than that of the T2DM group without documented microangiopathy and the normal control group ((217 ± 57),(105 ± 12),(74 ± 10) μg/ml,respectively with F =8.13 and P ＜ 0.05).Compared with the T2DM group without documented microangiopathy,the DN group showed significantly higher SDBG,MAGE,LAGE,MODD and AUC ((2.41 ±0.34),(7.9 ±0.4),(8.1 ±0.4),(2.51 ±0.3),(8.0 ±0.7) mmol/L,respectively with t =2.57,3.46,5.75,3.59,4.28 and P ＜ 0.05),while the DR group showed significantly higher SDBG,MAGE,LAGE,MODDand AUC((2.4 ±1.7),(7.9±0.4),(8.1 ±0.4),(3.1±1.6),(8.2±0.6)mmol /L,respectively with t =3.29,3.77,5.38,4.54,3.16 and P ＜0.05).The level of PDGF-BB,VEGF and the blood glucose fluctuation were the independent risk factors for the diabetic microangiopathy revealed by the logistic regression analysis.Taken the level of PDGF-BB and VEGF as the dependent variables,and the blood glucose fluctuation index of SDBG,LAGF,MAGE,MODD,AUC and 2 h PG as the independent variables,the multiple linear regression analysis showed the greatest impact of MAGE,SDBG and 2 h PG on the level of PDGF-BB and VEGF.Conclusion Bloot glucose fluctuation significantly correlates with the development and progression of the microangiopathy in type 2 diabetics.The level of VEGF and PDGF-BB could be increased by the blood glucose fluctuation,which may involve in the in the progression of the diabetic retinopathy and nephropathy.
