动态血糖参数正常参考值的建立及临床应用

目的建立动态血糖评估参数的正常参考值，为临床应用提供依据。方法采用动态血糖监测系统（CGMS）对48例正常糖调节者进行连续3d的血糖监测，并分析24h的平均血糖水平（MBG）及其标准差（SDBG）、餐前1h及餐后3h的MBG、血糖的时间百分比（PT）、血糖的曲线下面积（AUC）、最大血糖波动幅度（LAGE）、平均血糖波动幅度（MAGE）及日间血糖平均绝对差（MODD）。各参数非正态分布者以百分位数法估计95％的正常参考值范围，呈正态分布者按x±1.96s计算。结果（1）除血糖的frr及AUC呈非正态分布外（P〈0．05），其余参数均呈正态分布（P〉0．05），各参数在不同性别间的差异无统计学意义（P〉0．05）。（2）动态血糖参数的正常参考值上限：24hMBG〈6．5mmol／L，早、中及晚餐前1hMBG分别〈6．0mmol／L、〈6．3mmol／L和〈6．0mmol／L，早、中及晚餐后3hMBG分别〈7．0mmol／L、〈6．7mmol／L和〈7．0mmol／L，血糖≥7．8mmol／L及≤3．9mmol／L的PT分别〈9％和〈20％，血糖≥5．6mmol／L的AUC〈0．9d·mmol·L^-1，SDBG〈1．4mmol／L，LAGE〈5．7mmol／L，MAGE〈3．4mmol／L，MODD〈1．4mmol／L。（3）24hMBG与MAGE、MODD及SDBG均不相关（P〉0．05），MAGE与SDBG显著正相关（r=0．93，P〈0．01）。结论初步建立了CGMS各血糖参数的正常参考值，应用上述参数能较全面地反映受试者整体血糖水平和血糖稳定性的特征。

The reference values of glycemic parameters for continuous glucose monitoring and its clinical application

OBJECTIVE: To establish reference values of glycemic parameters for continuous glucose monitoring in Chinese. METHODS: Forty-eight individuals with normal glucose regulation were observed with continuous glucose monitoring system (CGMS) for 3 days. Indexes in CGMS were analyzed, including mean level of 24 h blood glucose (BG) values (24 h MBG) and its standard deviation (SDBG), percentage of time above 7.8 mmol/L or below 3.9 mmol/L, area under the curve (AUC) of BG above 5.6 mmol/L, the largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE) and absolute means of daily differences (MODD). RESULTS: (1) The upper limits of indexes for continuous glucose monitoring were as follows: 6.5 mmol/L for 24 h MBG, 6.0 mmol/L, 6.3 mmol/L and 6.0 mmol/L for mean BG levels 1 h before breakfast, lunch and dinner respectively, 7.0 mmol/L, 6.7 mmol/L and 7.0 mmol/L for mean BG levels 3 h after breakfast, lunch and dinner respectively, 1.4 mmol/L for SDBG, 5.7 mmol/L for LAGE, 3.4 mmol/L for MAGE and 1.4 mmol/L for MODD. The percentage of time over 7.8 mmol/L was less than 9%, while the percentage of time below 3.9 mmol/L was less than 20%. The AUC of BG above 5.6 mmol/L was less than 0.9 d x mmol x L(-1). There was no statistical difference among sex subgroups (P > 0.05). (2) The correlations of 24h MBG with MAGE, MODD and SDBG were not significant (P > 0.05). MAGE was positively correlated with SDBG (r = 0.93, P < 0.01). CONCLUSION: The reference values of glycemic parameters for continuous glucose monitoring are initially established and can be used as a temporary reference for clinical practice in Chinese. The CGMS profile can reflect the overall BG control and the feature of glycemic excursions in detail.