2018 年第 11 期 第 13 卷

糖化血红蛋白控制达标的2型糖尿病患者血糖波动与微血管并发症的相关性研究

Correlation between glycemic fluctuation and microvascular complication in type 2 diabetic patients with well-controlled glycosylated hemoglobin

作者：?魏嘉洁文丽娜周迎生

英文作者：

单位：100029首都医科大学附属北京安贞医院内分泌代谢科

英文单位：

关键词：2型糖尿病；动态血糖监测；血糖波动；微血管并发症

英文关键词：

• 摘要：

• 【摘要】目的    探讨糖化血红蛋白（HbA1c)控制达标的2型糖尿病患者24 h动态血糖变化与微血管并发症之间的相关性。方法    选取2012年9月至2017年12月就诊于首都医科大学附属北京安贞医院的2型糖尿病患者共66例，所有患者HbA1c＜7%，根据是否合并微血管并发症分为未合并微血管并发症组(A组，35例)和合并微血管并发症组(B组，31例)。检测所有患者HbA1c、空腹血糖、血脂、肝肾功能指标。用动态血糖监测系统监测全天血糖情况，记录指标包括平均血糖波动幅度（MAGE）、平均血糖标准差（SDBG）、24 h内平均血糖（MBG）、血糖最高值、血糖最低值、最大血糖波动幅度（LAGE）、M值、平均日风险范围（ADRR）。结果    A组与B组间空腹血糖、HbA1c差异无统计学意义（P＞0.05）。B组MAGE、SDBG、MBG、血糖最高值、LAGE、M值、ADRR均明显高于A组［（4.6±2.1）mmol/L比（2.9±1.1）mmol/L、（1.7±0.7）mmol/L比（1.3±0.4）mmol/L、（8.0±1.7）mmol/L比（7.2±1.1）mmol/L、（12.5±3.2）mmol/L比（10.2±1.6）mmol/L、（7.8±3.3）mmol/L比（5.6±1.9）mmol/L、3.6（2.0,8.9）比2.1(1.0,3.7)、（18±12）比（9±5）］，差异均有统计学意义（均P＜0.05）。Spearman相关分析结果显示，MAGE与空腹C肽和三酰甘油水平呈明显负相关（r＝-0.265、-0.280，均P＜0.05）。Logistic回归分析结果显示，MAGE是2型糖尿病患者发生微血管并发症的危险因素(比值比＝1.917，P＜0.01)。结论    血糖波动是HbA1c控制达标的2型糖尿病患者发生微血管并发症的危险因素。

• 【Abstract】Objective    To analyze the correlation between glycemic fluctuation and microvascular complication in type 2 diabetic patients with glycosylated hemoglobin(HbA1c)＜7%. Methods    Sixty-six type 2 diabetic patients with HbA1c＜7% were enrolled from September 2012 to December 2017 in Beijing Anzhen Hospital, Capital Medical University; 35 patients had microvascular complication（group A）; 31 patients without microvascular complication were group B. HbA1c, fasting blood glucose, blood lipid, liver and kidney function indexes were tested. Mean amplitude of glycemic excursions(MAGE), mean standard deviation of blood glucose（SDBG）, 24 h mean blood glucose（MBG）, maximum and minimum blood glucose, the largest amplitude of glycemic excursions(LAGE), M value and average daily risk range（ADRR） were monitored by the continuous glucose monitoring system. Results    Fasting blood glucose and HbA1c level showed no significant difference between the group A and group B（P＞0.05）. MAGE, SDBG, MBG, maximum blood glucose, LAGE, M value and ADRR in the group B were significantly higher than those in the group A［（4.6±2.1）mmol/L vs （2.9±1.1）mmol/L, （1.7±0.7）mmol/L vs （1.3±0.4）mmol/L, （8.0±1.7）mmol/L vs （7.2±1.1）mmol/L, （12.5±3.2）mmol/L vs （10.2±1.6）mmol/L, （7.8±3.3）mmol/L vs （5.6±1.9）mmol/L, 3.6（2.0,8.9） vs 2.1(1.0,3.7), （18±12） vs （9±5）］(P＜0.05). Spearman test showed that MAGE was negatively correlated with levels of fasting C-peptide and triglyceride（r＝-0.265, -0.280; P＜0.05）. Logistic regression indicated that MAGE was a risk factor of microvascular complication(odds ratio＝1.917, P＜0.01). Conclusion    Blood glucose fluctuation is an independent risk factor of microvascular complication in type 2 diabetic patients with HbA1c＜7%.