老年新诊断2型糖尿病病人血糖变异性与炎症因子及微血管病变关系的探讨

Association of blood glucose variability with inflammatory factors and microangiopathy in the elderly with newly diagnosed type 2 diabetes

目的探讨老年新诊断T2DM病人血糖变异性、炎症因子水平与微血管病变的关系。方法选择65例老年新诊断T2DM病人,根据24 h尿微量白蛋白排泄率(UAER)将病人分为2组正常蛋白尿组(UAER<25 mg/L)33例、早期糖尿病肾病(DN)组(UAER 25~200 mg/L)32例,另选择30例同期健康体检者作为正常对照组,分别采集静脉血,测定FPG、餐后2 h血糖(2hPBG)、HbA1c、BUN、血肌酐(SCr)、血脂、胱抑素C(Cys C)及炎症因子指标胰岛素样生长因子-1(IGF-1)、IL-6、TNF-α、hs-CRP。所有病人均佩戴动态血糖监测系统(CGMS)3 d,计算血糖波动参数。结果早期DN组血糖变异性参数血糖标准差(SD)、平均血糖波动幅度(MAGE)、日间血糖绝对差值(MODD)均大于正常蛋白尿组,炎症因子水平高于正常蛋白尿组,Cys C水平高于正常蛋白尿组、对照组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,MAGE、Cys C是老年T2DM慢性并发症的危险因素(P<0.05)。结论血糖波动变异性大增加了老年新诊断T2DM病人炎症因子的表达,对T2DM微血管病变有着重要的影响,Cys C在T2DM微血管病变病情评估中具有重要的临床意义。

Objective To investigate the association of blood glucose variability,inflammatory factor levels and microangiopathy in the elderly with newly diagnosed type 2 diabetes mellitus(T2DM).Methods Sixty-five elderly patients with newly diagnosed T2DM were selected and divided into two groups according to the level of urinary albumin excretionrate(UAER)normal proteinuria group(UAER<25 mg/L,n=33)and early diabetic nephropathy(DN)group(urine microalbumin 25-200 mg/L,n=32).Thirty cases receiving healthy physical examination were selected as normal control group.Fasting plasma glucose(FPG),two hours postprandial blood glucose(2hPBG),glycosylated hemoglobin(HbA1c),urea nitrogen(BUN),serum creatinine(SCr),blood lipids,cystatin C(Cys C),inflammatory factors such as insulin-like growth factor-1(IGF-1),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and hypersensitive C-reactive protein(hs-CRP)were measured and compared.All patients were observed by continuous glucose monitoring system(CGMS)for 3 days,and the blood glucose fluctuation parameters were calculated to assess the blood glucose variability.Results In the early DN group,the standard deviation of blood glucose(SD),mean amplitude of glycemic excursions(MAGE),and absolute means of daily differences(MODD)were higher than those in normal proteinuria group,and the levels of inflammatory factors were higher than those of the normal proteinuria group.The level of Cys C in early DN group was significantly higher than that of the normal proteinuria group and the control group(P<0.05).Logistic regression analysis showed that MAGE and Cys C were risk factors for chronic complications of T2DM in the elderly patients(P<0.05).Conclusions The variability of blood glucose fluctuation greatly increases the expression of inflammatory factors in the elderly patients with newly diagnosed T2DM,and has an important influence on diabetic microangiopathy.Cys C has important clinical significance in the assessment of diabetic microangiopathy.