中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2014年
1期
32-36
,共5页
鞠海兵%舒子正%李丽凤%宋洁%陈志娟%阮兆娟%陈瑛
鞠海兵%舒子正%李麗鳳%宋潔%陳誌娟%阮兆娟%陳瑛
국해병%서자정%리려봉%송길%진지연%원조연%진영
糖尿病,2型%血红蛋白A,糖基化%高血糖
糖尿病,2型%血紅蛋白A,糖基化%高血糖
당뇨병,2형%혈홍단백A,당기화%고혈당
Diabetes mellitus,type 2%Hemoglobin A,glycosylated%Hyperglycemia
目的 探讨2型糖尿病患者不同时间点血糖与糖化血红蛋白(HbA1c)的相关性及不同治疗方式时餐前和餐后血糖对HbA1c的贡献.方法 选择2010年6月至2012年10月就诊的病程超过1年、治疗相对稳定的2型糖尿病患者256例,男119例,女137例,年龄(54±14)岁,平均病程4.5年,平均空腹血糖9.6 mmol/L,平均HbA1c 8.4％.按治疗方式不同将患者分为口服药物治疗组(84例)、基础胰岛素治疗组(80例)和预混胰岛素治疗组(92例).各组再根据HbA1c的不同分成HbA1c ＜7％组、7％≤HbA1c＜ 8％组、8％≤HbA1c＜ 9％组、HbA1c≥9％组.不连续3d监测全天三餐前后和睡前7个时间点的血糖谱,取3d的平均值,同时免疫比浊法测定HbA1c.对各个时间点血糖与HbA1c进行单因素相关分析.三餐前及睡前四点血糖连线与正常血糖5.6 mmol/L平行线之间的面积为餐前血糖面积,三餐前和睡前四点血糖连线与三餐后血糖连线间的面积为餐后血糖面积,根据餐前血糖或餐后血糖面积与总高血糖面积的比值计算口服药物、基础胰岛素和预混胰岛素治疗组餐前和餐后血糖对HbA1c的贡献.结果 本组患者各个时间点血糖与HbA1c水平存在明显相关性(r =0.38 ～0.76,均P＜0.05),7点平均血糖与HbA1c相关性最强(r≥0.71,P＜0.05).口服药物治疗组餐前、餐后血糖对HbA1c的贡献分别为59％～ 82％、18％ ～41％;预混胰岛素治疗组餐前、餐后血糖对HbA1c的贡献分别为60％ ～ 82％、18％ ～ 40％;基础胰岛素治疗组餐前、餐后血糖对HbA1c的贡献分别为38％ ～66％、34％ ～ 62％.趋势检验表明,口服药物、基础胰岛素和预混胰岛素治疗组餐前血糖对HbA1c的相对贡献随着HbA1c的增加而增加(F=67.46、168.51、84.05,均P＜0.05),餐后血糖的相对贡献则相反.基础胰岛素治疗组在不同HbA1c状态下餐前血糖相对贡献较预混胰岛素治疗组低(HbA1c＜ 7％组:38％比66％,x2=5.94,P＜0.05;8％≤HbA1c＜9％组:63％比77％,x2=5.88,P＜0.05;HbA1c≥9％组:66％比82％,x2=5.51,P＜0.05).基础胰岛素治疗组在不同HbA1c状态下餐前血糖相对贡献较口服药物治疗组低(7％≤HbA1c＜ 8％组:50％比68％,x2 =5.56,P＜0.05;8％≤HbA1c ＜9％组:63％比78％,x2=5.79,P＜0.05;HbA1c≥9％组:66％比82％,x2=6.28,P＜0.05).结论 HbA1c与自我监测的各个时间点血糖明显相关,治疗方式及血糖控制状况影响餐前和餐后血糖对HbA1c的相对贡献.
目的 探討2型糖尿病患者不同時間點血糖與糖化血紅蛋白(HbA1c)的相關性及不同治療方式時餐前和餐後血糖對HbA1c的貢獻.方法 選擇2010年6月至2012年10月就診的病程超過1年、治療相對穩定的2型糖尿病患者256例,男119例,女137例,年齡(54±14)歲,平均病程4.5年,平均空腹血糖9.6 mmol/L,平均HbA1c 8.4％.按治療方式不同將患者分為口服藥物治療組(84例)、基礎胰島素治療組(80例)和預混胰島素治療組(92例).各組再根據HbA1c的不同分成HbA1c ＜7％組、7％≤HbA1c＜ 8％組、8％≤HbA1c＜ 9％組、HbA1c≥9％組.不連續3d鑑測全天三餐前後和睡前7箇時間點的血糖譜,取3d的平均值,同時免疫比濁法測定HbA1c.對各箇時間點血糖與HbA1c進行單因素相關分析.三餐前及睡前四點血糖連線與正常血糖5.6 mmol/L平行線之間的麵積為餐前血糖麵積,三餐前和睡前四點血糖連線與三餐後血糖連線間的麵積為餐後血糖麵積,根據餐前血糖或餐後血糖麵積與總高血糖麵積的比值計算口服藥物、基礎胰島素和預混胰島素治療組餐前和餐後血糖對HbA1c的貢獻.結果 本組患者各箇時間點血糖與HbA1c水平存在明顯相關性(r =0.38 ～0.76,均P＜0.05),7點平均血糖與HbA1c相關性最彊(r≥0.71,P＜0.05).口服藥物治療組餐前、餐後血糖對HbA1c的貢獻分彆為59％～ 82％、18％ ～41％;預混胰島素治療組餐前、餐後血糖對HbA1c的貢獻分彆為60％ ～ 82％、18％ ～ 40％;基礎胰島素治療組餐前、餐後血糖對HbA1c的貢獻分彆為38％ ～66％、34％ ～ 62％.趨勢檢驗錶明,口服藥物、基礎胰島素和預混胰島素治療組餐前血糖對HbA1c的相對貢獻隨著HbA1c的增加而增加(F=67.46、168.51、84.05,均P＜0.05),餐後血糖的相對貢獻則相反.基礎胰島素治療組在不同HbA1c狀態下餐前血糖相對貢獻較預混胰島素治療組低(HbA1c＜ 7％組:38％比66％,x2=5.94,P＜0.05;8％≤HbA1c＜9％組:63％比77％,x2=5.88,P＜0.05;HbA1c≥9％組:66％比82％,x2=5.51,P＜0.05).基礎胰島素治療組在不同HbA1c狀態下餐前血糖相對貢獻較口服藥物治療組低(7％≤HbA1c＜ 8％組:50％比68％,x2 =5.56,P＜0.05;8％≤HbA1c ＜9％組:63％比78％,x2=5.79,P＜0.05;HbA1c≥9％組:66％比82％,x2=6.28,P＜0.05).結論 HbA1c與自我鑑測的各箇時間點血糖明顯相關,治療方式及血糖控製狀況影響餐前和餐後血糖對HbA1c的相對貢獻.
목적 탐토2형당뇨병환자불동시간점혈당여당화혈홍단백(HbA1c)적상관성급불동치료방식시찬전화찬후혈당대HbA1c적공헌.방법 선택2010년6월지2012년10월취진적병정초과1년、치료상대은정적2형당뇨병환자256례,남119례,녀137례,년령(54±14)세,평균병정4.5년,평균공복혈당9.6 mmol/L,평균HbA1c 8.4％.안치료방식불동장환자분위구복약물치료조(84례)、기출이도소치료조(80례)화예혼이도소치료조(92례).각조재근거HbA1c적불동분성HbA1c ＜7％조、7％≤HbA1c＜ 8％조、8％≤HbA1c＜ 9％조、HbA1c≥9％조.불련속3d감측전천삼찬전후화수전7개시간점적혈당보,취3d적평균치,동시면역비탁법측정HbA1c.대각개시간점혈당여HbA1c진행단인소상관분석.삼찬전급수전사점혈당련선여정상혈당5.6 mmol/L평행선지간적면적위찬전혈당면적,삼찬전화수전사점혈당련선여삼찬후혈당련선간적면적위찬후혈당면적,근거찬전혈당혹찬후혈당면적여총고혈당면적적비치계산구복약물、기출이도소화예혼이도소치료조찬전화찬후혈당대HbA1c적공헌.결과 본조환자각개시간점혈당여HbA1c수평존재명현상관성(r =0.38 ～0.76,균P＜0.05),7점평균혈당여HbA1c상관성최강(r≥0.71,P＜0.05).구복약물치료조찬전、찬후혈당대HbA1c적공헌분별위59％～ 82％、18％ ～41％;예혼이도소치료조찬전、찬후혈당대HbA1c적공헌분별위60％ ～ 82％、18％ ～ 40％;기출이도소치료조찬전、찬후혈당대HbA1c적공헌분별위38％ ～66％、34％ ～ 62％.추세검험표명,구복약물、기출이도소화예혼이도소치료조찬전혈당대HbA1c적상대공헌수착HbA1c적증가이증가(F=67.46、168.51、84.05,균P＜0.05),찬후혈당적상대공헌칙상반.기출이도소치료조재불동HbA1c상태하찬전혈당상대공헌교예혼이도소치료조저(HbA1c＜ 7％조:38％비66％,x2=5.94,P＜0.05;8％≤HbA1c＜9％조:63％비77％,x2=5.88,P＜0.05;HbA1c≥9％조:66％비82％,x2=5.51,P＜0.05).기출이도소치료조재불동HbA1c상태하찬전혈당상대공헌교구복약물치료조저(7％≤HbA1c＜ 8％조:50％비68％,x2 =5.56,P＜0.05;8％≤HbA1c ＜9％조:63％비78％,x2=5.79,P＜0.05;HbA1c≥9％조:66％비82％,x2=6.28,P＜0.05).결론 HbA1c여자아감측적각개시간점혈당명현상관,치료방식급혈당공제상황영향찬전화찬후혈당대HbA1c적상대공헌.
Objective To investigate the contributions of preprandial and postprandial glucose to glycosylated hemoglobin A1c (HbA1 c) levels and their correlations in type 2 diabetic patients treated with different drugs.Methods A total of 256 patients with type 2 diabetes (T2DM) with diabetes duration longer than one year and relative fixed treatments were enrolled,which includes 119 males and 137 females.Among them,the average age was (54 ± 14) years,average diabetes duration was 4.5 years,average fasting glucose was 9.6 mmol/L,average HbA1c was 8.4％.The patients were divided into three groups:oral drug treatment group,basal insulin treatment group and premixed insulin treatment group.Each group was then subdivided according to HbA1c levels:＜7％ group,7％ ≤& ＜8％ group,8％ ≤& ＜9％ group,≥9％ group.The average of seven-point blood glucose from self-monitored blood glucose (SMBG) from three nonconsecutive days was calculated and plotted on glucose-time graph.Meanwhile HbA1c was measured with immunoassay and the correlation between seven-point blood glucose and HbA1c levels was evaluated using Pearson's correlation analysis.On the glucose-time curse,a curve was drawn to connect the three points representing preprandial glucose and the one point representing bedtime glucose.The area between this curve and the horizontal line at 5.6 mmol/L was calculated as the preprandial glucose volume.Another curve (postprandial) was also drawn to connect the three points representing postprandial glucose and the area between preprandial curve and postprandial curve was calculated as postprandial glucose volume.The contribution of pre-and post-prandial glucose to HbA1 c was determined by the ratio of pre-and post-prandial glucose volume over total glucose volume (pre-and post-prandial glucose volume together).Results There were significant correlation between HbA1c levels and seven-point self-monitored blood glucose (r =0.38 to 0.76,all P ＜ 0.05),and the mean of all seven-point blood glucose had the highest correlation with HbA1 c in all treatment groups (r≥0.71,P ＜0.05).The contribution of pre and post prandial glucose to HbA1c was 59％-82％,18％-41％ in oral drug treatment group,60％-82％,18％-40％ in basal insulin treatment group and 38％-66％,34％-62％ in pre-mixed insulin treatment group.Tendency analysis showed that the relative contribution of preprandial hyperglycemia increased gradually with increasing values of HbA1c in diabetic patients treated with oral drug and basal insulin and premixed insulin (F =67.46,168.51,84.05,P ＜ 0.05),but the relative contribution of postprandial hyperglycemia showed a gradual decrease with increasing values of HbA1 c.The relative contribution of preprandial hyperglycemia was lower in patients treated with basal insulin than treated with premixed insulin and oral antidiabetic drug (＜ 7％ group:38％ vs66％,8％≤&＜9％ group:63％ vs77％,≥9％ group:66％ vs82％,x2 =5.94,5.88,5.51,all P ＜ 0.05).Conclusions There are correlations between HbA1 c levels and self-monitored blood glucose testing at various times of the day.Glycemic control and the form of treatment on T2DM patients change the relative contribution of preprandial versus postprandial glucose to HbA1 C levels.
