血糖波动与下肢血管病变程度的关系研究

目的探讨糖化血红蛋白(HbA1c)控制良好的2型糖尿病(T2DM)患者慢性血糖波动与下肢血管病变程度的关系。方法对68例HbA1c≤6.5%的T2DM下肢血管病变患者(DM组)及30例健康者(NC组)进行72 h动态血糖监测,分析平均血糖波动幅度(MAGE)。然后以大于NC组MAGE的(x±1.96s)为MAGE升高的诊断标准,将DM组患者分为MAGE升高组和MAGE正常组,并对每个患者进行下肢血管病变评分。结果 (1)DM组高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、三酰甘油(TG)、HbA1c、MAGE与NC组比较,差异均有统计学意义(P<0.05)。(2)DM组患者中,MAGE升高36例,MAGE正常32例,两者的年龄、病程、HbA1c水平、下肢血管病变评分间差异有统计学意义(P<0.05)。Pearson相关分析显示,MAGE、年龄、病程、HDL-C与下肢血管病变评分相关(P<0.05);病程与MAGE相关(P<0.05)。(3)多元线性回归分析显示,病程、年龄、MAGE是下肢血管病变评分的影响因素(P<0.05)。结论慢性血糖波动是HbA1c控制良好的T2DM患者下肢血管病变的重要危险因素,糖尿病病程是影响血糖波动水平的重要因素。

Relationship between Blood Glucose Variability and Lower Extremity Vascular Disease in Type 2 Diabetic Patients

Objective To investigate the relationship between blood glucose variability and lower extremity vascular disease in type 2 diabetic patients with well-controlled glycosylated hemoglobin(HbA1c).Methods 68 diabetic patients having lower extremity vascular disease with HbA1c≤6.5%(DM group) and 30 subjects with normal glucose regulation(NC group) were monitored for 72 h by using continuous glucose monitoring system.The mean amplitude glycemic excursion(MAGE) was analyzed.MAGE greater than those of NC group(x-±1.96s) was taken as the diagnosing criterion for MAGE elevating.The diabetic patients with lower extremity vascular disease were divided into MAGE elevating group and MAGE normal group and each patient was graded on lower extremity vascular disease.Results(1) The levels of HDL-C,LDL-C,TC,TG,HbA1c and MAGE showed statistically significant differences in DM group compared with NC group(P<0.05).(2) Among the patients in DM group,36 cases had elevated MAGE and 32 cases had normal MAGE.The differences of age,disease course,levels of HbA1c and scores of lower extremity vascular disease between the 36 cases with elevated MAGE and the 32 cases with normal MAGE were statistically significant(P<0.05).Pearson correlation analysis showed that MAGE,age,course of disease and HDL-C were related to the score of lower extremity vascular disease(P<0.05).Course of disease was related to MAGE(P<0.05).(3) Multiple linear regression analysis showed that course of disease,age and MAGE were risk factors for the score of lower extremity vascular disease.Conclusion MAGE is the risk factor for lower extremity vascular disease in type 2 diabetic patients with well-controlled HbA1c,and course of disease is an important factor for MAGE.