2型糖尿病合并急性冠状动脉综合征患者早期血糖波动观察

目的探讨2型糖尿病(T2DM)合并急性冠状动脉综合征(ACS)患者早期血糖波动情况及意义。方法采用动态血糖监测系统对60例T2DM合并ACS患者(观察组),45例T2DM不伴ACS患者(对照组)进行3 d血糖检测,全球急性冠状动脉事件(GRACE)评分评价ACS患者危险度。比较两组血糖波动参数差异,并与不同GRACE评分组进行相关性分析。结果 (1)观察组餐后血糖波动幅度(PPGE)、日内平均血糖波动幅度(MAGE)、日内血糖平均绝对差(MODD)均明显高于对照组(3.53±1.43)mmol/L比(2.35±0.95)mmol/L;(3.46±1.23)mmol/L比(2.97±0.94)mmol/L;(2.54±0.92)mmol/L比(2.01±0.64)mmol/L,均为P<0.05];(2)GRACE评分为低危组、中危组和高危组ACS患者的PPGE、MAGE和MODD值比较差异有统计学意义(均为P<0.05);PPGE、MAGE、MODD和24 h平均血糖值与GRACE评分值呈正相关(r=0.604,0.504,0.492和0.581,均为P<0.05),多元线性回归分析显示MAGE是独立于射血分数及年龄的影响GRACE评分的危险因子。结论 T2DM患者合并ACS时,其早期血糖波动幅度明显增大,并且MAGE和GRACE评分相关。

Characteristics and clinical significance of blood glucose fluctuations in type 2 diabetes patients withacute coronary syndrome

Objective To explore the characteristics and clinical significance of blood glucose fluctuations in type 2 diabetes （T2DM） patients with acute coronary syndrome （ACS）. Methods Sixty T2DM patients with ACS （ observation group） and 45 T2DM patients （ control group） were monitored blood glucose consecutively for 72 hours. The GRACE score was assessed for ACS patients. Glycemic excursion parameters of two groups were compared. Correlation between the glycemic excursion parameter and GRACE score was analyzed. Results （ 1 ）The postprandial glycemic excursions PPGE （3.53 ± 1. 43 ） mmol/L], mean amplitude of glycemic excursions MAGE （ 3.46 ± 1.23 ） mmol/L ], and absolute mean of daily glycemic differences MODD （2. 54 ± 0. 92） mmol/L ] in observation group were significantly higher than control group PPGE （2. 35 ± 0. 95） mmol/L, MAGE （2. 97 ± 0. 94） mmoL/L, MODD （2. 01 ± 0. 64） mmol/L, all P 〈 0. 05 ]. （ 2 ） There were significant differences in PPGE, MAGE and MODD of low-risk group, the intermediate risk group, high-risk group of patients with ACS （ all P 〈 0.05 ）. PPGE, MAGE, MODD and 24 hMBG were all positively correlated with GRACE score （ r = 0. 604, 0. 504, 0. 492 and 0. 581, respectively, all P 〈 0. 05 ）. MAGE was risk factor of GRACE value independent of ejection fraction （EF） and age by multiple linear regression analysis. Conclusions Glycemic excursion range is significantly increased in T2DM patients with ACS, and MAGE is related with GRACE.