老年2型糖尿病患者血糖漂移幅度与颈动脉粥样硬化的相关性分析

Correlation analysis of carotid atherosclerosis and amplitude of glycemic excursion in elderly type 2 diabetic patients

目的探讨2型糖尿病(T_2DM)患者血糖漂移水平的差异与颈动脉内膜中层厚度(IMT)的关系。方法采用动态血糖监测系统(continuous glucose monitoring system,CGMS)对43例正常人及87例2型糖尿病患者进行连续71±10)h的血糖监测,分析日内不同时段的血糖水平、平均血糖漂移幅度(MAGE)及日间血糖平均色对差(MODD);并用多普超声观察颈动脉粥样硬化斑块的发生率及内中膜厚度,将糖尿病者分为A组(IMT<0.8mm)和B组(IMT≥0.8mm),与对照组C组进行比较。结果(1)糖尿病组的血压、血糖、血脂、糖化血红蛋白(HbAlc)及体质量指数(BMI)均高于对照组(P<0.05或P<0.01),而高密度脂蛋白(HDL-C)则降低(P<0.01);B组冠心病及脑血管病的百分比、糖尿病病程、收缩压、HbAlC、BMI及低密度脂蛋白(LDL-C)较A组有增高(P<0.05或P<0.01);IMT与负2h血糖的相关性最强(r=0.88,P<0.01),而与胰岛素敏感指数(ISI)呈负相关。(2)T_2DM组的颈动脉粥样硬化斑块的发生率及IMT增加(P<0.001);而CGMS显示的24hMBG、MAGE与IMT的相关性强(r=0.181,P<0.01)。(3)HbAlc与MBG呈正相关(r=0.82,P<0.01),而与MAGE、NGE及MODD均不相关。(4)研究还证明:CGMS观测值与血浆葡萄糖值及指端毛细血管血糖均呈正相关(r=0.93,r=0.95,P均<0.001)。结论T2DM患者的颈动脉粥样硬化不仅与血压、血糖、血脂、HbAlc及IMT有关,而且与血糖漂移水平的差异密切关联,相似的HbAlc水平其血糖漂移的程度可以不同,而血糖漂移幅度大的患者发生慢性并发症的危险性高。

Objectives To investigate the association between the range of blood glucose excursion and carotid intimate membrane thickness in elderly patients with type 2 diabetes. Methods 43 controls and 87 patients with type 2 diabetes were monitored for blood glucose by a continuous glucose monitoring system. The occurrence of carotid atherosclerotic plaques and thickness of the carotid intimate membrane were observed by ultrasonic Doppler. Patients with type 2 diabetes were divided into group A （IMT 〈 0.8mm） and group B （IMT ≥ 0.8mm）, and both of them were compared with controls （C group）. Results 1. Blood pressure, blood glucose, serum lipids, HbAlc and body mass index （BMI） in type 2 diabetic patients were significantly higher than those of controls, while high-density lipoprotein cholesterol was significantly decreased. IMT was most positively correlated with 2h BG and was significantly negatively correlated with insulin sensitive index; 2. The occurrence of carotid atherosclerotic plaques and thickness of the carotid intimate membrane in patients with type 2 diabetes were significantly increased compared with controls. 24h MBG and MAGE were most correlated with IMT （r = 0.181, P 〈 0.01）; 3. HbAlc was significantly positively correlated with MBG. The correlation between HbAlc and MAGE, NGE or MODD was not observed; and 4. CGMS value was significantly positively correlated with plasma glucose and capillary glucose. Conclusions Carotid atherosclerosis was not only associated with blood pressure, blood glucose, serum lipid profile, HbAlc and IMT, but also closely correlated with the range of blood glucose excursion. A similar HbAlc level may show different ranges of blood glucose excursion, and patients with a larger range of blood glucose excursion have higher risks for developing chronic complications.