2型糖尿病患者血糖波动与颈动脉血管病变的关系探讨

目的探讨糖化血红蛋白、血糖波动与2型糖尿病(T2DM)患者颈动脉内膜中层厚度(IMT)的关系。方法应用动态血糖监测系统(CGMS)对104例2型糖尿病患者血糖连续监测3d,计算平均空腹血糖(MFBG)、平均餐后2h血糖(MPBG)、平均血糖水平(MBG)、血糖水平标准差(SDBG)、平均血糖漂移幅度(MAGE)、血糖波动最大幅度(LAGE),低血糖时间比(血糖<3.9mmol/L),并测血压、血脂、糖化血红蛋白(HbA1c)。同时采用彩色多普超声检测颈动脉粥样硬化斑块发生及内中膜厚度,根据病变程度分为A组(无病变)、B组(有病变组)。结果 B组的年龄、病程、收缩压(SBP)、低密度脂蛋白胆固醇(LDL-C)、HbA1c均高于A组(P<0.05),差异有统计学意义;两组间性别、舒张压(DBP)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油之间无差异。B组MAGE、SD大于A组(P<0.05),LAGE、MPBG、低血糖时间比明显大于A组(P<0.01),两组间MBG、MFBG无差异。结论预防2型糖尿病患者颈动脉血管病变,除积极降压、调脂,控制空腹、HbA1c达标外,还应积极控制餐后血糖、降低血糖波动幅度,减少低血糖的发生。

The Relationship between Glucose Variability and Carotid Atherosclerosis in Type 2 Diabetic Patients

Objectives To investigate the association of hemoglobin A 1 c and glucose variability with carotid intimate media thickness in type 2 diabetes mellitus patients. Methods 104 patients with type 2 diabetes were monitored for blood glucose by a continuous glucose monitoring system （CGMS） for 3 days. We examined the mean fasting blood glucose （MFBG）, mean post blood glucose （MPBG）, mean blood glucose （MBG）, standard deviation of blood glucose （SDBG）, mean amplitude of glycemic excursion （MAGE）, largest amplitude of glycemic excursion （LAGE）, percentage of time below 3.9mmol/L. Blood pressures （BP）, serum lipids, HbA 1 c were measured. The occurrence of carotid intimate media thickness （IMT） was observed by ultrasonic Doppler. Patients with type 2 diabetes were divided into two groups by various levels of carotid intimate media thickness. Results 1. The age, duration of diabetes,systolic blood pressure （SBP）, low density lipoprotein cholesterol （LDL-c） and HbA 1 C in the group B were higher than the group A. 2. MAGE,SD,LAGE、MPBG, percentage of time below 3.9mmol/L in the group B were significantly increased compared with the group A （P〈0.01）. Conclusions For prevent the carotid atherosclerosis in type 2 diabetic patients, we must not only bring high blood pressure down, adjust serum lipids, control FBG, PBG and HbA 1 c up to the standard positively, but also reduce the glucose variability.