2型糖尿病合并急性脑梗死患者血糖波动与颈动脉内中膜厚度的相关性研究

目的探讨2型糖尿病（T2DM）合并急性脑梗死患者血糖波动与颈动脉内中膜厚度（IMT）的相关性。方法选择50例T2DM，依据是否合并脑梗死分为T2DM合并脑梗死组（DMCI组）30例及单纯T2DM组（T2DM组）20例。所有患者均佩戴动态血糖监测系统（CGMS）进行72h血糖监测，同时测血脂、糖化血红蛋白（HbA1C），并应用彩色高频多普勒超声诊断仪检测IMT，以IMT=0．9mm为切点，将DMCI组分为IMT正常组（IMT〈0．9mm）与IMT增厚组（IMT≥0．9mm）。比较DMCI组与T2DM组以及1MT正常组与IMT增厚组之间的血糖波动及血脂、HbA1c、血压水平，并将上述指标与IMT值进行相关性分析。结果①DMCI组与T2DM组日内平均血糖波动幅度（MAGE）、IMT、血压、低密度脂蛋白（LDL）、甘油三酯（TG）、总胆固醇（TC）、HbA1C比较，差异有统计学意义（P〈0．05）；②DMCI组中IMT正常13例，IMT增厚17例，IMT正常组与IMT增厚组MAGE、收缩压（SBP）、LDL、IMT差异有统计学意义（P〈0．01）；③相关性分析：MAGE、SBP、LDL与IMT显著相关（r=0．912、r=0．851、r=0．850，P〈0．01），以IMT为因变量，MAGE、血脂、HbA1c、血压、病程为自变量进行多元逐步回归分析，MAGE、LDL、SBP进入最终方程。结论T2DM合并急性脑梗死患者的血糖波动幅度明显升高，且动脉粥样硬化程度更重，在高效降糖的同时应平稳降糖，以降低动脉硬化的风险，延缓心脑血管并发症。

Relationship between the Glucose Fluctuation with Carotid lntima-Media Thickness in Patients with Type 2 Dia- betes Mellitus Complicated with Acute Cerebral Infarction

Objective To investigate the relationship between the glucose fluctuation with carotid intima-media thickness （IMT） in patients with type 2 diabetes mellitus （T2DM） complicated with acute cerebral infarction （ACI）. Methods A total of 50 patients with T2DM were divided into T2DM complicated with ACI （ group A, n = 30） and only T2DM （group B, n = 20）. All patients were monitored for 72 h with the continuous glucose monitoring system （CGMS） , and levels of blood fat and glyeated hemoglobin （HbAlc） were also detected at the same time. The IMT value was detec- ted by high frequency of color ultrasonic Doppler. The patients in group A were divided into IMT normal group （ IMT 〈 0. 9 ram） and IMT thicking group （IMT≥0.9 mm） according to IMT =0.9 of tangential point. The glucose fluctuation, blood fat, HbAlc and blood pressure level were compared in the four groups, and the correlations between IMT with the above values were also analyzed. Results The differences in mean amplitude of glycemic excursions （MAGE） , IMT, blood pressure, low density lipoprotein （LDL） , triglyceride （TG）, total cholesterol （TC） and HbAlc between group A and B were statistically significant （P 〈0.05） ; there were 13 patients with normal IMT and 17 with thieking 1MT, and the differences in MAGE, systolic blood pressure （SBP） , LDL and IMT between IMT normal group and IMT thicking group were statistically significant （P 〈 0.01 ）. The correlation analysis showed that IMT was significantly correlated with MAGE, SBP and LDL （ r = 0. 912, r = 0.851 , r = 0. 850, P 〈 0.01 ）. The multiple stepwise regression analysis showed that the MAGE, LDL and SBP went into the final equation with IMT as the dependent variables and MAGE, blood fat, HbAlc, blood pressure and disease course as independent variables. Conclusion The blood glucose fluctuation in pa-tients with T2DM complicated with ACI is significantly higher, and the atherosclerosis （AS） degree is more severe. So the glucose shouht be steadily reduced at the same time of high-performance reducing glucose in order to decrease the AS incidence and postpone cerebrovascular complications.