糖尿病心肌病患者血糖波动与结缔组织生长因子的关系

目的观察糖化血红蛋白低于7％的糖尿病心肌病患者血糖波动与血清结缔组织生长因子水平的关系及其临床意义。方法选取2009年10月至2010年7月在黑龙江省医院内分泌科就诊的2型糖尿病患者50例，其中男25例，女25例，年龄30～50岁，根据是否合并糖尿病心肌病分为单纯2型糖尿病组[n=25，男13例，女12例，年龄（41±5）岁]和糖尿病心肌病组[n=25，男12例，女13例，年龄（43±6）岁]。另以同期于黑龙江省医院进行体检的20名健康志愿者为正常对照组[男11例，女9例，年龄（40±5）岁]。应用动态血糖监测系统连续监测血糖3d，计算平均血糖波动幅度及日间血糖绝对差值。采用酶联免疫吸附法检测血清结缔组织生长因子水平。采用方差分析和多元逐步回归分析进行数据统计。结果糖尿病心肌病组血清结缔组织生长因子水平明显高于单纯2型糖尿病组和正常对照组[分别为（311±32）、（211±29）、（181±38）ng／L，F=81．53，P〈0．05]。糖尿病心肌病组平均血糖波动幅度[分别为（7．1±1．0）、（6．0±1．0）mmol／L，F=25．46，P〈0．05]、日间血糖平均绝对差[分别为（2．56±0．38）、（1．37±0．26）mmol／L，F=66．13，P〈0．05]明显高于单纯2型糖尿病组。Pearson直线相关分析显示，血清结缔组织生长因子水平与餐后2h血糖、24h尿微量白蛋白、平均血糖波动幅度、日问血糖平均绝对差呈正相关（r值分别为0．759、0．655、0．491、0．617，均P〈0．05）。结论血糖波动可能通过影响血清结缔组织生长因子水平参与糖尿病心肌病的发展，结缔组织生长因子表达上调对糖尿病心肌病的诊断及预后有重要的临床意义。

Relationship between glycemic fluctuation and serum level of connective tissue growth factor in patients with diabetic cardiomyopathy

Objective To investigate the relationship between glycemic fluctuation and serum level of connective tissue growth factor (CTFG) in patients with diabetic cardiomyopathy (DC).Methods Twenty healthy controls (male 11,famale 9,aged (40 ± 5) years old) and 50 patients with type 2 diabetes mellitus (T2DM) whose HbAIc were less than 7％ were enrolled in this investigation.T2DM patients were further assigned to the non-DC group (n =25,male 13,female 12,aged (41 ±5) years old) and the DC group (n =25,male 12,female 13,aged (43 ±6) years old).All the participants underwent continuous glucose monitoring for 3 days to evaluate mean amplitude of glycemic excursion (MAGE) and the absolute mean of daily differences (MODD).Serum CTGF levels were measured by enzyme-linked immunosorbent assay.Analysis of variance and multiple stepwise regression analysis were used for data comparison.Results CTGF levels were significantly increased in DC group ( (311 ± 32) ng/L) than in non-DC group ( (211 ±29) ng/L) and normal control group ((181 ±38) ng/L) (F=81.53,P＜0.05).MAGE and MODD in DC group were significantly higher than non-DC group ( MAGE:( 7.1 ± 1.0 ) mmol/L vs ( 6.0 ± 1.0)mmol/L; MODD:(2.56 ±0.38) mmol/L vs (1.37 ±0.26) mmol/L; F values were 25.46 and 66.13,respectively; both P ＜ 0.05 ).Serum CTGF levels were positively correlated with 2-h postprandial blood glucose,24-h urinary albumin,MAGE and MODD (r values were 0.759,0.655,0.491 and 0.617,respectively; all P ＜ 0.05 ).Conclusions These findings suggest that increased glycemic fluctuation may play a role in the development of DC.Increased serum CTGF level may be an important factor in the diagnosis and prognosis of DC.