2型糖尿病患者血糖波动与颈动脉内膜中层厚度相关性研究

【目的】探讨2型糖尿病（T2DM）患者血糖（BG）波动与颈动脉内膜中层厚度（IMT）的相关性。【方法】选取本院长期随访的T2DM患者，根据彩超测定结果将病例分为颈动脉IMT增厚组（A组，IMT≥0．9mm）和颈动脉IMT正常组（B组，IMT〈0．9mm），测量各组糖化血红蛋白（HbAlc）、空腹胰岛素（FINs）及餐后2h胰岛素（2hiNS）、空腹及餐后2hC肽、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）。采用自我血糖监测（SMBG）方式记录检测结果，共24周。【结果】两组患者空腹血糖（FBG）无统计学差异（P〉0．05），但三餐后血糖（PBG）水平、空腹平均血糖标准差（SDBG）、餐后SDBG均有统计学差异（P〈0．05）。线性相关分析显示，IMT（转换后）与年龄、TC、TG、SBP、DBP、FBG、早餐后2hPBG、午餐后2hPBG、晚餐后午餐后2hPBG、空腹SDBG、餐后SDBG的线性相关关系显著（P〈0．05），与性别、病程（转换后）、BMI、HbAlc（转换后）、HDL、LDL、FINS、2hFINS、空腹C肽、餐后2hC肽的相关关系不显著（P〉0．05）。偏相关分析显示IMT（转换后）与TC、TG、SBP、FBG、早餐后2hPBG、午餐后2hPBG、晚餐后午餐后2hPBG、空腹sDBG、餐后sDBG的相关关系显著（P〈0．05），与DBP的相关关系不显著（P〉0．05）。以IMT（转换后）为因变量，多元逐步回归分析显示餐后sDBG、TC依次进入方程。【结论】血糖波动，尤其是餐后血糖波动与T2DM患者颈动脉IMT厚度密切相关。

Relationship Between Glucose Fluctuations and Carotid Intima-media Thickness of Carotid Artery in Type 2 Diabetic Patients

[Objective]To explore the relationship between blood glucose fluctuations and carotid intimamedia thickness（IMT） in type 2 diabetic patients. [Methods] Type 2 diabetic patients by long-term follow-up in our hospital were selected. IMT of both sides of carotid arteries were measured by B-mode ultrasonography. According to the IMT results, all patient were divided into thickening carotid IMT group（group A, IMTG0. 9ram） and normal carotid IMT（group B, IMT;0.9mm）. Hemoglobin Alc（HbAlc）, fasting insulin（FINS）, 2-hour postprandial insulin（2hlNS）, fasting and postprandial 2h-C-peptide, total cholesterol（TC）, triglycer- ides（TG）, HDL-C and LDL-C of two groups were measured. Self-monitoring of blood glucose（SMBG） was used to record the results for 24 weeks. [Results]No statistical difference of FPG was found between two groups（ P〉0.05）, but there were significant differences in blood glucose after 3 meals, fasting standard deviation of blood glucose （SDBG） and postprandial SDBG （ P 〈 0.05）. Linear regression analysis showed that IMT had significant linear correlation with age, TC, TG,SBP, DBP, FBG, post-breakfast 2hPBG, post-lunch 2hPBG, post-dinner 2hPBG, fasting SDBG and postprandial SDBG（ P 〈0.05）, but its relation with gender, course of disease, BMI, HbAlc, HDL, LDL, FINS, 2hFINS, fasting C-peptide and postprandial 2h-C-peptide was not significant（ P 〉0. 05）. Partial correlation analysis showed that IMT was obviously associated with TC, TG, SBP, FBG, post-breakfast 2hPBG, post-lunch 2hPBG, post-dinner 2hPBG, fasting SDBG and postprandial SDBG（ P G0.05）, but its relation with DBP was not significant（ P〉0.05）. Stepwise multivariate linear regression analysis showed that SDBG and TC were identified as the significant and independent risk factors for IMT. [Conclusion] Blood glucose fluctuations, especially postprandial blood glucose fluctuations have a strong association with carotid IMT of type 2 diabetic patients.