老年2型糖尿病患者糖化白蛋白及糖化血红蛋白与血糖波动的相关性

目的：分析住院老年2型糖尿病患者糖化血清白蛋白（GA）、糖化血红蛋白（HbA1c）与平均血糖波动幅度（MAGE）、血糖标准差（SDBG）的相关性,为临床全面评价GA和HbA1c提供理论依据。方法研究对象来源于上海交通大学附属第六人民医院内分泌代谢科2013年2月至2014年2月住院的660例老年2型糖尿病患者，入院后第2天测定静脉空腹血糖（FPG）、HbA1c、GA、空腹C肽（FCP）及餐后2h血糖（2hPBG）、餐后2hC肽（2hCP）等。采用动态血糖监测系统（CGMS）对研究对象进行连续3d的血糖监测。采用MAGE和SDBG评估研究对象的血糖波动程度，采用CGM中连续48h的平均血糖水平（MBG）评估整体血糖水平。结果（1）660例研究对象中男346例、女314例。年龄（66±6）岁，糖尿病病程8.0（4.0～13.8）]年，HbA1c为8.2（6.7～9.6）]%,GA为21.1（17.6～25.9）]%，MAGE为5.3（3.9～7.2）]mmol/L，SDBG为2.1（1.6～2.7）]mmol/L，MBG为8.6（7.3～10.1）]mmol/L。（2）单相关分析GA与HbA1c之间有良好的相关性（r＝0.836，P＜0.01）。GA与FPG、2hPBG、MBG呈正相关（r分别为0.604，0.670，0.650，均P＜0.01）；HbA1c与FPG、2hPBG、MBG呈正相关（r分别为0.603，0.634，0.661，均P＜0.01）。（3）单相关分析GA与MAGE、SDBG呈正相关（r分别为0.485，0.529，均P＜0.01）；HbA1c与MAGE、SDBG呈正相关（r分别为0.417、0.495，均P＜0.01）。（4）逐步多元回归分析显示，GA水平与血糖波动参数MAGE和SDBG水平独立相关。结论与HbA1c相比，GA能更好地反映餐后血糖的水平及血糖的波动情况。

Association of glycosylated albumin and glycosylated hemoglobin A1c with glycemic excursions in elderly type 2 diabetic patients

Objective To analyze the correlation of glycosylated albumin （GA） and glycosylated hemoglobin A1c （HbA1c） with mean amplitude of glycemic excursions （MAGE） and standard difference of blood glucose （SDBG） in elderly type 2 diabetic patients, so as to provide theoretical evidences for complete assessment of GA and HbA1c. Methods A total of 660 elderly type 2 diabetic patients hospitalized in our department from February 2013 to February 2014 were enrolled in this study. Fasting plasma glucose （FPG）, HbA1c, GA, fasting C peptide （FCP）, 2-hour postprandial blood glucose （2hPBG）, and 2-hour C peptide （2hCP） were examined in all the subjects. The 3-day continuous blood glucose monitoring of the enrolled subjects were performed by continuous glucose monitoring system. MAGE and SDBG were used to assess to glycemic excursions. Mean blood glucose （MBG） was used to assess the overall glucose level. Results （1） Among the 660 enrolled subjects, there were 346 men and 314 women with age of （66±6） years, diabetes course of 8.0（4.0？13.8）years, HbA1c of 8.2% （6.7%？9.6%）, GA of 21.1% （17.6%？25.9%）, MAGE of 5.3（3.9？7.2）mmol/L, SDBG of 2.1（1.6？2.7）mmol/L, and MBG of 8.6（7.3？10.1）mmol/L. （2） Univariate correlation analysis showed that GA was significantly correlated with HbA1c （r=0.836, P〈0.01）, and also positively correlated with FPG, 2hPBG and MBG （r=0.604, 0.670 and 0.650, respectively, P〈0.01）. HbA1c also had positive correlation with FPG, 2hPBG and MBG （r=0.603, 0.634 and 0.661, respectively, P〈0.01）. （3） Univariate correlation analysis indicated that GA had positive correlation with MAGE and SDBG （r=0.485 and 0.529, P〈0.01）. HbA1c＆nbsp;was also positively correlated with MAGE and SDBG （r=0.417 and 0.495, P〈0.01）. （4） Stepwise multivariate regression analysis demonstrated that GA level was independently correlated with the glycemic excursion indices, MAGE and SDBG. Conclusion Compared with HbA1c, GA can re