2型糖尿病患者血糖波动与颈动脉内膜中层厚度的关系

目的探讨2型糖尿病(T2DM)患者血糖波动与颈动脉内膜中层厚度(CIMT)的关系。方法连续纳入2009年7月至2012年3月在我院内分泌科住院的T2DM患者64例,所有患者均应用高分辨彩色多谱勒超声诊断仪测定CIMT以及动态血糖监测系统(CGMS)进行72h血糖监测,并检测糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)等。根据CIMT<0.9mm将患者分为CIMT正常组(A组,n=37)和CIMT增厚组(B组,n=27)。结果①A组患者年龄、收缩压、LN(LDL-c)、LN〔日间血糖平均绝对差(MODD)〕均小于B组,差异有统计学意义(P均<0.05);但两组患者性别、糖尿病病程、体质量指数(BMI)、糖尿病慢性并发症、糖尿病家族史、舒张压、TG、TC、HDL-c以及日内血糖波动指标平均血糖的标准差(SD)与平均血糖波动幅度(MAGE)无明显差异(P>0.05)。②Pearson相关分析显示:糖尿病患者CIMT与年龄、LN(LDL-c)、LN(MODD)、SD相关,r值分别为:0.370(P=0.005)、0.325(P=0.009)、0.346(P=0.005)、0.251(P=0.045)。③多重线性回归分析显示:患者年龄、吸烟、LN(LDL-c)、LN(MODD)是CIMT的重要危险因素。结论 T2DM患者血糖波动是导致动脉粥样硬化的重要危险因素,且独立于HbA1c之外。

Association of Glycaemic Variability and Carotid Intima-media Thickness in Patients with Type 2 Diabetes Mellitus

Objective To investigate the relationship between blood glucose fluctuations and carotid intima-media thickness(CIMT) in type 2 diabetic patients.Methods 64 patients with type 2 diabetes mellitus(T2DM) in the Department of Endocrinology and Metabolism,West China Hospital from July 2009 to March 2012 were recruited in this study.The CIMT were measured bilaterally with high-resolution ultrasonography.The glucose excursions were assessed by the following parameters obtained from the continuous glucose monitoring system(CGMS) for 72 h: mean blood glucose(MBG) and its standard deviation(SD),mean amplitude of glycemic excursion(MAGE),mean of daily differences(MODD).Glycosylated hemoglobin(HbA1c),triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-c),and low-density lipoprotein cholesterol(LDL-c) of the participants were also determined.According to the levels of CIMT,64 diabetic patients were classified into two groups: diabetes mellitus without atherosclerosis(A group,n=37) and diabetes mellitus with atherosclerosis(B group,n=27).The relationship between the parameters of glycaemic variability and CIMT was examined.Results ①There were no differences between A group and B group with regard to gender composition,course of diabetes,body mass index(BMI),diabetic chronic complications,family history of diabetes,smoking,alcohol drinking,diastolic blood pressure(DBP),TG,TC,HDL-c,SD and MAGE(P>0.05).A group had younger age and lower levels of systolic blood pressure(SBP),LN(LDL-c) and LN(MODD) than B group(P<0.05).②Pearson correlation analyses showed that CIMT was positively correlated with age(r=0.370,P=0.005),LN(LDL-c)(r=0.325,P=0.009),SD(r=0.251,P=0.045) and LN(MODD)(r=0.346,P= 0.005).③Age,smoking,LN(LDL-c) and LN(MODD) were identified as predictors for CIMT in the multiple linear regression analysis.Conclusion Glucose excursions may contribute to the development of atherosclerosis in pat ients with type 2 diabetes,which is independent from HbA1c levels.