中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
Chinese Journal of Diabetes Mellitus
2015年
10期
624-628
,共5页
李晨光%倪长霖%常宝成%杨敏%汤云昭%朱艳娟%李竹%姜振环%于萍
李晨光%倪長霖%常寶成%楊敏%湯雲昭%硃豔娟%李竹%薑振環%于萍
리신광%예장림%상보성%양민%탕운소%주염연%리죽%강진배%우평
糖尿病,2型%睡眠呼吸暂停,阻塞性%血糖波动%微血管并发症
糖尿病,2型%睡眠呼吸暫停,阻塞性%血糖波動%微血管併髮癥
당뇨병,2형%수면호흡잠정,조새성%혈당파동%미혈관병발증
Diabetes mellitus,type 2%Sleep apnea,obstructive%Blood glucose fluctuation%Microvascular complications
目的 探讨2型糖尿病(T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者夜间血糖波动与微血管并发症的关系.方法 选择2014年6月至12月我院住院诊断为T2DM合并OSAHS患者55例为病例组,其中男性34例,女性21例,平均年龄(61±6)岁,未合并OSAHS的T2DM患者55例为对照组,其中男性30例,女性25例,平均年龄(60±5)岁.检测血糖、血脂、糖化血红蛋白(HbA1c)、24 h尿微量白蛋白(UMA)等相关生化指标.采用动态血糖监测系统(CGMS)监测两组患者平均血糖波动幅度(MAGE)、夜间血糖水平的标准差(SDBG)、日间血糖平均绝对差(MODD)以及最大血糖波动幅度(LAGE)、低血糖时间百分比(<3.9 mmol/L)、高血糖时间百分比(>7.8 mmol/L)、高血糖时间百分比(>11.1 mmol/L)及血糖波动系数,采用多导睡眠图(PSG)监测睡眠呼吸暂停指数(AHI),并检测患者微血管并发症发生情况.采用t检验、?2检验、方差分析、Pearson积矩相关分析、Logistic多因素分析进行数据统计. 结果 (1)随着AHI的增加,其MAGE、SDBG、MODD、LAGE、低血糖时间百分比(<3.9 mmol/L)及血糖波动系数也随之增加(F=28.137、26.226、19.802、17.734、29.132、29.404,均P<0.05).(2)AHI与MAGE、SDBG及血糖波动系数呈正相关(r=0.465、0.696、0.533,均P<0.05).(3)病例组的微血管并发症发生率明显高于对照组,差异有统计学意义(81.8%比32.7%,?2=27.08,P<0.05).(4) Logistic 分析显示 HbA1c(OR=9.646,95%CI:2.381~39.076)、AHI[7.435(1.834~30.134)]、MAGE[10.052 (1.057~95.622)]、SDBG[6.435(1.414~29.287)]、LAGE[12.199(2.322~99.613)]、血糖波动系数[8.511(2.012~35.787)]、糖尿病病程[11.769(3.642~43.005)]是T2DM合并微血管并发症的危险因素.结论 合并OSAHS可增加T2DM患者血糖波动幅度及频率,T2DM合并OSAHS患者夜间血糖波动与微血管并发症有关.
目的 探討2型糖尿病(T2DM)閤併阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)患者夜間血糖波動與微血管併髮癥的關繫.方法 選擇2014年6月至12月我院住院診斷為T2DM閤併OSAHS患者55例為病例組,其中男性34例,女性21例,平均年齡(61±6)歲,未閤併OSAHS的T2DM患者55例為對照組,其中男性30例,女性25例,平均年齡(60±5)歲.檢測血糖、血脂、糖化血紅蛋白(HbA1c)、24 h尿微量白蛋白(UMA)等相關生化指標.採用動態血糖鑑測繫統(CGMS)鑑測兩組患者平均血糖波動幅度(MAGE)、夜間血糖水平的標準差(SDBG)、日間血糖平均絕對差(MODD)以及最大血糖波動幅度(LAGE)、低血糖時間百分比(<3.9 mmol/L)、高血糖時間百分比(>7.8 mmol/L)、高血糖時間百分比(>11.1 mmol/L)及血糖波動繫數,採用多導睡眠圖(PSG)鑑測睡眠呼吸暫停指數(AHI),併檢測患者微血管併髮癥髮生情況.採用t檢驗、?2檢驗、方差分析、Pearson積矩相關分析、Logistic多因素分析進行數據統計. 結果 (1)隨著AHI的增加,其MAGE、SDBG、MODD、LAGE、低血糖時間百分比(<3.9 mmol/L)及血糖波動繫數也隨之增加(F=28.137、26.226、19.802、17.734、29.132、29.404,均P<0.05).(2)AHI與MAGE、SDBG及血糖波動繫數呈正相關(r=0.465、0.696、0.533,均P<0.05).(3)病例組的微血管併髮癥髮生率明顯高于對照組,差異有統計學意義(81.8%比32.7%,?2=27.08,P<0.05).(4) Logistic 分析顯示 HbA1c(OR=9.646,95%CI:2.381~39.076)、AHI[7.435(1.834~30.134)]、MAGE[10.052 (1.057~95.622)]、SDBG[6.435(1.414~29.287)]、LAGE[12.199(2.322~99.613)]、血糖波動繫數[8.511(2.012~35.787)]、糖尿病病程[11.769(3.642~43.005)]是T2DM閤併微血管併髮癥的危險因素.結論 閤併OSAHS可增加T2DM患者血糖波動幅度及頻率,T2DM閤併OSAHS患者夜間血糖波動與微血管併髮癥有關.
목적 탐토2형당뇨병(T2DM)합병조새성수면호흡잠정저통기종합정(OSAHS)환자야간혈당파동여미혈관병발증적관계.방법 선택2014년6월지12월아원주원진단위T2DM합병OSAHS환자55례위병례조,기중남성34례,녀성21례,평균년령(61±6)세,미합병OSAHS적T2DM환자55례위대조조,기중남성30례,녀성25례,평균년령(60±5)세.검측혈당、혈지、당화혈홍단백(HbA1c)、24 h뇨미량백단백(UMA)등상관생화지표.채용동태혈당감측계통(CGMS)감측량조환자평균혈당파동폭도(MAGE)、야간혈당수평적표준차(SDBG)、일간혈당평균절대차(MODD)이급최대혈당파동폭도(LAGE)、저혈당시간백분비(<3.9 mmol/L)、고혈당시간백분비(>7.8 mmol/L)、고혈당시간백분비(>11.1 mmol/L)급혈당파동계수,채용다도수면도(PSG)감측수면호흡잠정지수(AHI),병검측환자미혈관병발증발생정황.채용t검험、?2검험、방차분석、Pearson적구상관분석、Logistic다인소분석진행수거통계. 결과 (1)수착AHI적증가,기MAGE、SDBG、MODD、LAGE、저혈당시간백분비(<3.9 mmol/L)급혈당파동계수야수지증가(F=28.137、26.226、19.802、17.734、29.132、29.404,균P<0.05).(2)AHI여MAGE、SDBG급혈당파동계수정정상관(r=0.465、0.696、0.533,균P<0.05).(3)병례조적미혈관병발증발생솔명현고우대조조,차이유통계학의의(81.8%비32.7%,?2=27.08,P<0.05).(4) Logistic 분석현시 HbA1c(OR=9.646,95%CI:2.381~39.076)、AHI[7.435(1.834~30.134)]、MAGE[10.052 (1.057~95.622)]、SDBG[6.435(1.414~29.287)]、LAGE[12.199(2.322~99.613)]、혈당파동계수[8.511(2.012~35.787)]、당뇨병병정[11.769(3.642~43.005)]시T2DM합병미혈관병발증적위험인소.결론 합병OSAHS가증가T2DM환자혈당파동폭도급빈솔,T2DM합병OSAHS환자야간혈당파동여미혈관병발증유관.
Objective To investigate the association between blood glucose fluctuation and microvascular complications in type 2 diabetes mellitus patients complicated with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods 55 patients(34 males and 21 females,with an average of (61 ± 6) years old) complicated with OSAHS were enrolled as case group,and 55 patients (30 males and 25 females, with an average of (60±5)years old) without OSAHS were enrolled as control group.Blood glucose, blood lipid, glycosylated hemoglobin A1c (HbA1c),and 24 h urinary microalbumin (24 hUMA) was detected. Dynamic glucose monitoring system(CGMS) was used to monitor the values of mean amplitude of glycemic excursions (MAGE),standard deviation of blood glucose (SDBG), mean of daily differences (MODD),largest amplitude of glycemic excursions (LAGE),the low blood glucose time percentage(<3.9 mmol/L), high blood glucose time percentage(>7.8 mmol/L), high blood glucose time percentage(>11.1 mmol/L) and blood glucose fluctuation coefficient.Apnea hypopnea index (AHI) was monitored by polysomnography (PSG), microvascular complications of all patients were also detected.t test,χ2 test,variance analysis, Pearson product moment correlation analysis and Logistic multivariate analysis were used to evaluate the data. Results (1)The values of MAGE,SDBG, MODD,LAGE,low blood glucose time percentage(<3.9 mmol/L) and blood glucose fluctuation coefficient(F=28.137,26.226,19.802,17.734,29.132,29.404,all P<0.05) were significantly increased with the increase of AHI.(2)AHI was positively related with MAGE,SDBG, and blood glucose fluctuation coefficient (r=0.465,0.696,0.533,all P<0.05). (3) The incidence of microvascular complications in case group (81.8%) was significantly higher than that in control group (32.7%, ?2=27.08, P<0.05).(4) Logistic analysis showed that HbA1c(OR=9.646,95%CI:2.381-39.076), AHI(OR=7.435,95%CI:1.834-30.134), MAGE(OR=10.052, 95%CI:1.057-95.622), SDBG(OR=6.435,95%CI:1.414-29.287), LAGE(OR=12.199,95%CI:2.322-99.613),blood glucose fluctuation coefficient (OR=8.511,95%CI:2.012-35.787), the duration of diabetes (OR=11.769,95%CI: 3.642-43.005) was the risk factor of T2DM compliaced with microvascular complication. Conclusions The merger of OSAHS could increase blood glucose fluctuation and frequency in T2DM patients.Nocturnal glucose fluctuation was associated with microvascular complications in T2DM patients complicated with OSAHS.
