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2型糖尿病患者血糖波动与颈动脉内膜中层厚度的关系
Association of Glycaemic Variability and Carotid Intima-media Thickness in Patients with Type 2 Diabetes Mellitus
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摘要: 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72 h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<0.9 mm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。Abstract: 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=[CM(154.5mm]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 patients with type 2 diabetes, which is independent from HbA1c levels.
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