CAJ | 학술논문

目的探讨2型糖尿病患者睡眠障碍与黎明现象的关系.方法应用匹兹堡睡眠质量指数将2011年7月至2014年7月天津医科大学代谢病医院收治的316例行动态血糖监测、资料完整的2型糖尿病患者分为无睡眠障碍组(186例)和睡眠障碍组(130例),测定肝肾功能、血脂、糖化血红蛋白(HbA1c)、果糖胺等生化指标,行口服葡萄糖耐量试验及胰岛素、胰高糖素释放试验,比较两组血糖水平、空腹和糖负荷后胰岛α和β细胞功能变化,对睡眠障碍行相关及回归分析.结果睡眠障碍组HbA1c、果糖胺、空腹血糖与夜间最低点血糖净增值、早餐后与早餐前血糖净增值、24 h平均血糖、空腹胰岛素、稳态模型-胰岛素抵抗指数(HOMA-IR)、胰岛素曲线下面积均显著高于无睡眠障碍组[(8.2±2.0)％比(7.4±1.7)％,(0.33±0.10)比(0.29 ±0.07) mmol/L,(1.511 ±0.294)比(0.889±0.233) mmol/L,(2.144±0.400)比(1.522±0.378) mmol/L,(9.917±1.800)比(8.694±1.622) mmol/L,(13.49±4.68)比(12.16±4.56) mU/L,4.98±0.90比3.82±0.82,8.47 ±0.59比8.25 ±0.54](均P＜0.05).睡眠障碍组胰岛素敏感指数显著低于无睡眠障碍组(-4.28 ±0.62比-4.03 ±0.52),各时间点胰高糖素水平及胰高糖素曲线下面积均显著高于无睡眠障碍组,0、30、180 min胰高糖素/胰岛素比值及胰高糖素/血糖比值也均显著高于无睡眠障碍组(均P＜0.05).睡眠障碍与HOMA-IR、胰高糖素/胰岛素比值、空腹血糖与夜间最低点血糖净增值、黎明现象均呈正相关,与胰岛素敏感指数呈负相关(均P＜0.05).结论睡眠障碍与黎明现象相关,改善睡眠障碍可能有助于改善黎明现象,从而优化整体血糖控制.
목적 탐토2형당뇨병환자수면장애여려명현상적관계.방법 응용필자보수면질량지수장2011년7월지2014년7월천진의과대학대사병의원수치적316례행동태혈당감측、자료완정적2형당뇨병환자분위무수면장애조(186례)화수면장애조(130례),측정간신공능、혈지、당화혈홍단백(HbA1c)、과당알등생화지표,행구복포도당내량시험급이도소、이고당소석방시험,비교량조혈당수평、공복화당부하후이도α화β세포공능변화,대수면장애행상관급회귀분석.결과 수면장애조HbA1c、과당알、공복혈당여야간최저점혈당정증치、조찬후여조찬전혈당정증치、24 h평균혈당、공복이도소、은태모형-이도소저항지수(HOMA-IR)、이도소곡선하면적균현저고우무수면장애조[(8.2±2.0)％비(7.4±1.7)％,(0.33±0.10)비(0.29 ±0.07) mmol/L,(1.511 ±0.294)비(0.889±0.233) mmol/L,(2.144±0.400)비(1.522±0.378) mmol/L,(9.917±1.800)비(8.694±1.622) mmol/L,(13.49±4.68)비(12.16±4.56) mU/L,4.98±0.90비3.82±0.82,8.47 ±0.59비8.25 ±0.54](균P＜0.05).수면장애조이도소민감지수현저저우무수면장애조(-4.28 ±0.62비-4.03 ±0.52),각시간점이고당소수평급이고당소곡선하면적균현저고우무수면장애조,0、30、180 min이고당소/이도소비치급이고당소/혈당비치야균현저고우무수면장애조(균P＜0.05).수면장애여HOMA-IR、이고당소/이도소비치、공복혈당여야간최저점혈당정증치、려명현상균정정상관,여이도소민감지수정부상관(균P＜0.05).결론 수면장애여려명현상상관,개선수면장애가능유조우개선려명현상,종이우화정체혈당공제.
Objective To explore the association between sleep disorders and dawn phenomenon in patients with type 2 diabetes mellitus (T2DM).Methods From July 2011 to July 2014 at Metabolic Disease Hospital,Tianjin Medical University,316 T2DM patients on continuous glucose monitoring were divided into two groups according to the Pittsburgh Sleep Quality Index,i.e.those without sleep disorders (n =186) and those with sleep disorders (n =130).Biochemical parameters including hepatorenal functions,blood lipids,glycosylated hemoglobin (HbA1c) and fructosamine were detected.Oral glucose tolerance test,insulin releasing test and glucagon releasing test were performed to detect the inter-group differences of glucose concentration and α-cell and β-cell functions after fasting and glucose loading.And the correlation and regression analyses were performed between sleep disorders and other parameters.Results The level of HbA1c,fructosamine,increment of fasting glucose and nocturnal nadir glucose,glucose increment before and after breakfast,24 h mean glucose,fasting insulin,homeostasis model assessment of insulin resistance index (HOMA-IR) and area under curve of insulin were significantly higher in patients with sleep disorders than those without sleep disorders (8.2％ ±2.0％ vs 7.4％ ± 1.7％,(0.33 ±0.10) vs (0.29 ±0.07) mmol/L,(1.511 ±0.294) vs (0.889 ±0.233) mmol/L,(2.144 ±0.400) vs (1.522±0.378) mmol/L,(9.917±1.800) vs (8.694±1.622) mmol/L,(13.49±4.68) vs (12.16±4.56) mU/L,4.98 ± 0.90 vs 3.82 ± 0.82,(8.47 ±0.59) vs (8.25 ±0.54),all P＜0.05).Insulin sensitivity index was lower in patients with sleep disorders than that in those without sleep disorders (-4.28 ± 0.62 vs-4.03 ± 0.52,P ＜ 0.05).The level of glucagon at each timepoint and area-undercurve of glucagon were significantly higher in patients with sleep disorders than those without sleep disorders.The levels of 0,30,180 min glucagon/insulin ratio and glucagon/glucose ratio were significantly higher in patients with sleep disorders (all P ＜ 0.05).Sleep disorder was positively correlated with HOMA-IR,glucagon/insulin ratio,increment of fasting glucose and nocturnal nadir glucose and dawn phenomenon (all P ＜ 0.05).Yet there was a negative correlation with insulin sensitivity index (P ＜ 0.05).Conclusions Sleep disorders are associated with dawn phenomenon.And improving sleep disorder helps to improve the dawn phenomenon and optimize overall glycemic control.