糖化血红蛋白水平和血糖波动与氧化应激关系的研究

目的探讨HbA₁c水平、血糖波动与氧化应激(OS)的关系。方法选取2017年8月至2019年8月于山西白求恩医院内分泌科住院的新诊断T2DM患者115例,分为低HbA₁c(5.5%~6.5%)组、中HbA₁c(6.5%~7.5%)组、高HbA₁c(7.5%~8.5%)组,行持续葡萄糖监测,记录包括平均血糖波动幅度(MAGE)、血糖标准差(SDBG)、最大血糖波动幅度(LAGE)及日间血糖平均绝对差(MODD);ELISA法测定OS血清指标8-羟基脱氧鸟苷(8-OHdG),分析HbA₁c水平和血糖波动与8-OHdG的关系。结果与低HbA₁c组比较,中HbA₁c组SDBG、MAGE升高(P<0.05);高HbA₁c组LAGE、SDBG、MAGE及MODD均高于低HbA₁c、中HbA₁c组(P<0.05)。随着HbA₁c水平升高,各组8-OHdG水平依次升高(P<0.01)。Pearson相关性分析显示,HbA₁c水平与LAGE、SDBG、MAGE及MODD呈正相关(P<0.01),高HbA₁c组8-OHdG与MAGE呈正相关(r=0.202,P=0.036)。结论 SDBG、MAGE是反映血糖波动更敏感的指标,HbA₁c<7.5%时显示血糖异常波动。T2DM患者血糖波动随HbA₁c水平升高而增加,OS随血糖波动增加而加重。

Relationship between HbAc levels and blood glucose fluctuations and oxidative stress

Objective To investigate the relationship between glycated hemoglobin(HbA₁c) levels and blood glucose fluctuations and oxidative stress.Methods A total of 120 patients with new-onset of type 2 diabetes mellitus(T2DM) were grouped by HbA₁c:5.5%~6.5%, 6.5%~1.5%, and 7.5%~8.5%.Continuous glucose monitoring was used to obtain blood glucose fluctuation parameters:mean amplitude of glycemic excursions(MAGE), standard deviation of blood glucose level(SDBG), largest blood glucose fluctuation(LAGE), and absolute means of daily difference(MODD).Serum oxidative stress indicator8-hydroxydeoxyguanosine(8-OHdG) was determined by enzyme-linked immunosorbent assay.The relationship between HbA₁c levels and blood glucose fluctuations and 8-OhdG was analyzed.Results Compared with the low group,SDBG and MAGE increased in middle group(P<0.05).Compared with low and middle HbA₁c group,LAGE,SDBG,MAGE and MODD increased in high HbA₁c group(P<0.05).The level of 8-OHdG increased with the increase of HbA₁c level(P<0.01).HbA₁c levels were positively correlated with LAGE,SDBG,MAGE and MODD(P<0.01).In high group,8-OHdG was positively correlated with MAGE(r=0.202,P=0.036).Conclusion SDBG and MAGE are sensitive indicators in reflecting blood glucose fluctuations,even in patients with HbA₁c<7.5%.The blood glucose fluctuations of patients with new-onset of T2DM increased with the increase of HbA₁c level, and the level of oxidative stress increased with the increase of blood glucose fluctuations.