不同糖调节者血糖波动与血浆8-异前列腺素F2α水平的相关性研究

目的 探讨血糖波动对氧化应激的作用.方法 入选33例糖调节正常者(NGR)、25例槠调节异常者(IGR)和25例新诊断2型糖尿病患者(T2DM).酶联免疫法测定血浆8-异前列腺素F2α(8-iso)水平;动态血糖临测系统(CGMS)评价3组受试者24 h平均血糖(MBG)和血糖标准差(SDBG),24 h各时段平均血糖、24 h内血糖>5.6 mmol/L的曲线下而积(AUC 5.6)、日内血糖波动幅度(MAGE)、日内平均餐后血糖漂移幅度(MPPGE)及日间血糖平均绝对差(MODD).结果 (1)T2DM组血浆8-iso水平中位数为230 ng/L,高于IGR(199 ng/L,P<0.05)和NGR组(156ng/L,P<0.01);(2)T2DM组糖化血红蛋白(HbAlc)、MBG、SDBG、24 h各时段平均血糖、AUC5.6、MAGE、MPPGE和MODD均高于IGR组(P<0.05,0.01),IGR组的上述指标高于NGR组(P<0.05,0.01);(3)血浆8-iso水平(对数)与MAGE(r=0.747,P=0.00)、SDBG(r=0.691,P=0.00)、MPPGE(r=0.615,P=0.00)、MBG(r=0.562,P=0.0)、AUC5.6、MODD、24 h各时段平均血糖及HbAlc(r=0.463,P=0.00)呈正相关;以血浆8-iso水平为应变量,MAGE、MBG和SDBG进入多元线性回归模型(R2=0.55,P<0.05),MAGE为影响血浆8-iso水平的最主要因素(r=0.694,P=0.000).结论 IGR和T2DM患者存在明显的日内和日间血糖波动,氧化应激增加;日内血糖波动对氧化应激的作用强于持续高血糖.

Correlation between the amplitude of glucose excursion and plasma 8-iso prostaglandin F2α level in subjects with different types of glucose regulation

Objective To investigate the effect of glucose excursion on oxidative stress that is expressed by plasma 8-isu prostaglandin F2α (8-iso) level. Methods Continuous glucose monitory system (CGMS) was used to calculate the mean amplitude of glycemic excursion (MAGE), mean blood glucose (MBG) and its standard deviation (SDBG), mean 1 h preprandial glucose value (1 h-prePG) and 3 h post-prandial glucose value (3 h PPG) over 24 h period, area under the ROC curve when the blood glucose within 24 h > 5.6 mmol/L (AUC 5.6), mean of daily differences (MODD), and mean postprandial glucose excursion (MPPGE) on 33 individuals with normal glucose regulation (NGR), 25 subjects with impaired glucose regulation (IGR), and 25 patients with newly diagnosed type 2 diabetes mellitus (T2DM) for 3 days. Plasma 8-iso level was determined by EIA. Results The plasma 8-iso level of the T2DM patients was 230 ng/L, significantly higher than that of the subjects with IGR (199 ng/L, P<0.05) and that of the NGR subjects (156 ng/L, P<0.01). Patients with T2DM also had higher levels of glycated hemoglobin (HbAlc), MBG, SDBG, 1 h pre-PG and 3 h PPG, MAGE, and MODD than those of the NGR and IGR subjects (P<0.05 or 0.01). The plasma 8-iso level and parameters of glucose excursion of the IGR subjects were all significantly higher than those of the NGR individuals (P<0.05 or 0.01) . Plasma 8-iso level was positively correlated with MAGE, MBG, SDBG, 1 h pre-PG, 3 h PPG, MODD, and HbAlc in all groups. Further analysis showed that the relationship between plasma 8-iso level and MAGE remained significant after adjustment for the other parameters of glucose excursion in multiple linear regression analysis (multiple R2=0.55 for the model including MAGE). Standardized regression coefficients were 0.694 (P=0.000) for MAGE. Conclusion Glucose excursion exhibits a stronger triggering effect on oxidative stress than chronic sustained hyperglycemia in the subjects with IGR and T2DM.