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目的探讨血糖波动对2型糖尿病(T2DM)患者内皮功能以及炎性状态的影响。方法使用肱动脉内皮依赖性舒张功能(FMD)反映内皮功能,以超敏C反应蛋白(hs-CRP)反映机体炎性状态。对糖化血红蛋白(Hb A1C)≤6.5%的T2DM患者进行动态血糖监测(CGMS),选取50例平均血糖(MBG)>3倍血糖标准差(SD)的患者为血糖波动较小组(Ⅰ组),另选50例平均血糖≤3倍血糖标准差的患者为血糖波动较大组(Ⅱ组)。比较两组FMD、hs-CRP水平,探讨血糖波动对内皮功能以及炎性状态的影响。结果Ⅱ组的hs-CRP及日内平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、平均餐后血糖波动幅度(MPPGE)、日间血糖平均绝对差(MODD)明显高于Ⅰ组,而FMD明显低于Ⅰ组(P<0.05)。MAGE和SBP是FMD的独立危险因素,而LAGE、HOMA-IR(胰岛素抵抗指数)和MPPGE是hs-CRP的独立危险因素。结论 2型糖尿病患者血管内皮功能和hs-CRP受血糖波动影响较大。
Objective To investigate the effect of blood glucose fluctuation on endothelial function and inflammatory status in patients with type 2 diabetes mellitus (T2DM). Methods The brachial artery endothelium-dependent vasodilation (FMD) was used to reflect the endothelial function and the hs-CRP was used to reflect the inflammatory status of the body. Dynamic blood glucose monitoring (CGMS) was performed on T2DM patients with Hb A1C ≤ 6.5%. 50 patients with average blood glucose (MBG)> 3 times blood glucose standard deviation (SD) Another 50 patients with mean blood glucose ≤ 3 times the standard deviation of blood glucose in patients with large fluctuations in blood sugar (Ⅱ group). The levels of FMD and hs-CRP in both groups were compared to explore the effect of blood glucose fluctuation on endothelial function and inflammatory status. Results The hs-CRP, mean intra-day blood glucose (MAGE), LAGE, mean postprandial blood glucose (MPPGE) and mean daytime blood glucose (MODD) in group Ⅱ were significantly higher than those in group Ⅰ While FMD was significantly lower than that of group Ⅰ (P <0.05). MAGE and SBP are independent risk factors for FMD, while LAGE, HOMA-IR (Insulin Resistance Index) and MPPGE are independent risk factors for hs-CRP. Conclusion The vascular endothelial function and hs-CRP in patients with type 2 diabetes are greatly influenced by blood glucose fluctuations.