论文部分内容阅读
目的探讨2型糖尿病患者血糖波动对下肢血管病变的影响。方法选取2013年2至9月在北京军区总医院内分泌科住院治疗并行超声检查的2型糖尿病患者56例为研究对象,其中合并下肢血管病变者29例(A组),男15例,女14例,年龄(61±10.64)岁,单纯2型糖尿病者27例(B组),男15例,女12例,年龄(58.5±4.14)岁。应用动态血糖监测仪对两组患者行连续72 h血糖监测并计算各血糖波动参数,包括日内平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、日间血糖平均绝对差(absolute means of daily differences,MODD)、全天血糖标准差(standard deviation of blood glucose,SDBG)、全天有效血糖波动次数(effective blood glucose fluctuations in frequency,NGE)、血糖>10 mmol/L曲线下面积(blood glucose>10 mmol/L area under the curve,AUC10)、血糖<3.9 mmol/L曲线下面积(blood glucose<3.9 mmol/L area under the curve,AUC3.9),同时测定踝肱指数(ankle-brachial index,ABI)、缺血修饰白蛋白(ischemia-modified albumin,IMA)、8-异前列腺素2α(8-iso-prostaglandin 2α,8-iso-PGF2α)水平,比较两组间ABI、IMA、8-iso-PGF2α及各血糖波动参数,并分析各组血糖波动参数及临床生化指标与ABI、IMA、8-iso-PGF2α的相关性。相关性分析采用Pearson相关和多元逐步回归分析,P<0.05为差异有统计学意义。结果 (1)A组患者的病程[(159.2±65.33)个月]、IMA[(92.0±3.84)U/ml]、8-iso-PGF2α[(3.87±0.44)ng/ml]、MAGE[(7.06±0.59)mmol/L]、MODD[(3.58±0.59)mmol/L]、SDBG[(2.79±0.91)mmol/L]、NGE[(4.07±0.83)次/d]、AUC10[(2.72±1.34)h×mmol/L]、AUC3.9[(1.80±0.09)h×mmol/L]比B组[(78.6±15.66)个月、(75.6±3.07)U/ml、(1.92±0.21)ng/ml、(5.95±0.74)mmol/L、(1.75±0.11)mmol/L、(2.21±0.82)mmol/L、(2.62±0.57)次/d、(1.12±0.14)h×mmol/L、(0.12±0.04)h×mmol/L]均明显升高,差异均有统计学意义(P<0.05),且A组ABI(0.53±0.15)明显低于B组(0.97±0.06)。(2)采用Pearson相关分析表明:MAGE、SDBG、MODD、AUC10与IMA呈正相关(r值为0.711、0.942、0.423、0.495,P均<0.05);MAGE、MODD、SDBG与8-iso-PGF2α也呈正相关(r值为0.863、0.639、0.746,P均<0.05);且MAGE、MODD、AUC10与ABI呈负相关(r值为-0.337,-0.668,-0.422,P均<0.05)。多因素逐步回归分析发现:MODD、AUC10与ABI独立相关(Y=21.136-0.462MODD-0.379AUC10)。结论血糖波动与下肢血管病变相关,可能是通过诱发氧化应激及缺血性内皮损伤而引起。
Objective To investigate the influence of blood glucose fluctuation on the vascular diseases of lower extremities in type 2 diabetic patients. Methods From February to September 2013, 56 patients with type 2 diabetes mellitus who underwent simultaneous ultrasound examination in Department of Endocrinology, Beijing Military Region General Hospital were enrolled. Among them, 29 patients (group A) with lower extremity vascular lesions, 15 males and 14 females Cases, age (61 ± 10.64) years, simple type 2 diabetes in 27 patients (group B), 15 males and 12 females, age (58.5 ± 4.14) years. The ambulatory blood glucose monitor was used to monitor the blood glucose of the two groups for 72 hours continuously and calculate the parameters of blood glucose fluctuation, including mean amplitude of glycemic excursions (MAGE), absolute means of daily differences , MODD), standard deviation of blood glucose (SDBG), effective blood glucose fluctuations in frequency (NGE), blood glucose> 10 (AUC10, mmol / L area under the curve, AUC10), blood glucose <3.9 mmol / L, blood glucose <3.9 mmol / L area under the curve, AUC3.9, and ankle-brachial index , Iso-prostaglandin 2α (8-iso-PGF2α), ischemia-modified albumin (IMA) and 8-iso- PGF2α and the parameters of blood glucose fluctuation, and analyzed the correlation between blood glucose fluctuation parameters and clinical biochemical indexes and ABI, IMA, 8-iso-PGF2α in each group. Correlation analysis using Pearson correlation and multiple stepwise regression analysis, P <0.05 for the difference was statistically significant. RESULTS: The duration of [(159.2 ± 65.33) months], IMA (92.0 ± 3.84) U / ml and 8-iso-PGF2α [(3.87 ± 0.44) ng / 7.06 ± 0.59 mmol / L], MODD [(3.58 ± 0.59) mmol / L], SDBG [(2.79 ± 0.91) mmol / L], NGE [(4.07 ± 0.83) (78.6 ± 15.66) months, (75.6 ± 3.07) U / ml, (1.92 ± 0.21) (1.75 ± 0.11) mmol / L, (2.21 ± 0.82) mmol / L, (2.62 ± 0.57) times / d, (1.12 ± 0.14) mmol / L, , (0.12 ± 0.04) h × mmol / L], the differences were statistically significant (P <0.05). The ABI of group A was significantly lower than that of group B (0.97 ± 0.06). (2) Pearson correlation analysis showed that there was a positive correlation between MAGE, SDBG, MODD, AUC10 and IMA (r = 0.711,0.942,0.423,0.495, P <0.05); MAGE, MODD, SDBG and 8-iso-PGF2α (R = 0.863,0.639,0.746, P <0.05). There was a negative correlation between MAGE, MODD, AUC10 and ABI (r = -0.337, -0.668, -0.422, P <0.05). Multivariate stepwise regression analysis found that MODD and AUC10 were independently associated with ABI (Y = 21.136-0.462MODD-0.379AUC10). Conclusion The fluctuation of blood glucose is associated with lower extremity vascular lesions, which may be caused by inducing oxidative stress and ischemic injury.