2型糖尿病患者血糖波动与下肢血管病变的关系

目的探讨2型糖尿病（T2DM）血糖波动与下肢血管病变的关系。方法以2012年3月-2013年6月在北京军区总医院内分泌科住院治疗且行72h动态血糖监测的57例T2DM为研究对象，按超声检查结果分为T2DM合并重度下肢血管病变组10例（A组）、T2DM合并轻中度下肢血管病变组15例（B组）、单纯T2DM组32例（c组）。对3组的临床资料及动态血糖参数进行比较。结果A、B组病程、收缩压、LDL均显著高于c组（P〈0．05）。日内平均血糖波动幅度（MAGE）、日间血糖平均绝对差（MODD）、平均餐后血糖漂移幅度（MPPGE）均比c组明显增加（P〈0．05），A组血糖标准差（SDBG）比c组明显增加（P〈0．05）。A组病程、MAGE、SDBG、MODD均比B组明显增加（P〈0．05）。结论血糖波动与T2DM下肢血管病变程度关系密切，制定临床方案时除降压、降脂，控制糖化血红蛋白之外，更应重视平稳降糖。

Relationship of Blood Glucose Fluctuations in Patients with Type 2 Diabetes Mellitus Complicated with Lower Extremity Vascular Disease

Objective To investigate the relationship between blood sugar fluctuations in type 2 diabetes mellitus （T2DM） complicated with lower extremity vascular disease. Methods A total of 57 patients with T2DM admitted into our hospital and underwent 72 hours of continuous glucose monitoring during March 2012 and June 2013 were selected for the study. According to the ultrasonography results, the patients were divided into T2DM complicated with severe lower extremity vascular disease group （group A, n = 10） , complicated with mild-to-moderate lower extremity vascular disease group （group B, n = 15 ） and pure T2DM group （group C, n = 32）. Clinical data and dynamic glycemic parameters of pa- tients in the three groups were compared. Results The course of disease, systolic blood pressure and low density lipopro- tein （LDL） in group A and B were significantly increased than those in group C （P 〈 0. 05）. Levels of mean amplitude of glycemic excursions （MAGE） , absolute means of daily difference （MODD） , mean postprandial glucose excursion （ MP- PGE） in group A and B were significantly higher than those in group C （P 〈 0. 05 ） , and level of standard deviation of blood glucose （SDBG） in group A was significantly higher than that in group C （P 〈 0. 05）. The values of disease course, MAGE, SDBG and MODD in group A were significantly higher than those in group B （P 〈0. 05）. Conclusion Glucose fluctuation in T2DM is closely related with the degree of lower extremity vascular disease, so clinical protocols should be aimed at steadily reducing glucose level in addition to controlling blood pressure, blood fat and glycosylated hemoglobin.