血糖波动对2型糖尿病肾病发病的影响

Correlation between blood glucose fluctuation and diabetic nephropathy

目的:探讨血糖波动对2型糖尿病患者肾病并发症的影响。方法:采用动态血糖监测系统(CGMS)对68例2型糖尿病患者进行连续24 h血糖监测,以24 h内平均血糖标准差(SDBG)反映血糖波动;通过测定24 h尿蛋白定量(24 h-UAE)描述肾病并发症的程度,并行平均动脉压、血脂、糖化血红蛋白(hemoglobin A1c,HbA1c)、体质量指数(body mass index)测量。结果:(1)2型糖尿病无肾病并发症、合并早期肾病并发症、合并临床肾病并发症的患者SDBG分别为(1.64±0.45),(1.87±0.43),(2.82±0.81)mmol/L。(2)相关分析显示,相同条件下,经对数变换后的24 h-UAE与SDBG的相关系数为0.612,与平均动脉压的相关系数为0.558(P<0.01)。(3)线性回归分析显示,经对数变换后的24h-UAE与SDBG、平均动脉压的β值分别为0.519,0.451。结论:初步认为血糖波动与2型糖尿病肾病并发症的发生发展有相关性。

Objective： To discuss the correlation between blood glucose fluctuation and diabetic nephropathy. Methods： Sixty-eight individuals with type 2 diabetes mellitus were observed with continuous glucose monitoring system（CGMS） for 24 hours. Analyze the standard deviation of mean level of blood glucose fluctuation within 24 hours （SDBG）. To determine the level of 24 h-urinary albumin excretion for defining diabetic nephropathy. Mean arterial pressure, blood fat, hemoglobin Alc and body mass index were measured. Results： （ 1 ） The SDBG were 1.64 ± 0.45, 1.87 ±0.43 and 2.82 ± 0.81 mmoL/L, respectively in patients with normoalbuminuria, microalbuminuria and macroalbuminuria. （2） It was indicated by correlation analysis that under the same circumstance the correlation coefficient between 24 h-UAE after logarithmic transformation and SDBG was 0.612 and the correlation coefficient between 24 h-UAE after logarithmic transformation and mean arterial pressure was 0. 558 （ P 〈 0.01 ）. （ 3 ） It was indicated by linear regression analysis that the value of 13 between 24 h-UAE after logarithmic transformation and SDBG and 24 h-UAE after logarithmic transformation and mean arterial pressure was 0. 519 and 0.451 respectively. Conclusion： It was initially considered that blood glucose fluctuation may be associated with diabetic nephropathy.