糖化血红蛋白控制理想的2型糖尿病患者血糖波动特征及其与微量白蛋白尿的关系

Relationship between blood glucose variability and microalbuminuria in type 2 diabetic patients with well-controlled glycosylated hemoglobin

目的探讨糖化血红蛋白（HbAle）控制理想的2型糖尿病患者血糖波动与微量白蛋白尿（MAU）的关系及影响因素。方法对176例HbAlc〈6．5％的2型糖尿病患者及48名正常糖调节者（对照组）进行动态血糖监测（CGM），分析比较CGM中连续48h的平均血糖水平（MBG）及平均血糖波动幅度（MAGE）。结果（1）2型糖尿病患者MBG及MAGE分别为（7．0±0．9）mmol／L、（3．8±2．5）mmol／L，均高于对照组（5．4±0．6）mmol／L、（2．0±0．7）mmol／L（P〈0．01）。（2）以超过对照组MAGE的x＋1．965（3．4mmol／L）定为MAGE升高的诊断标准，176例患者中MAGE升高者为91例（51．7％），其MAU的发生率高于MAGE水平正常的2型糖尿病患者（18．7％比7．1％，P〈0．05）。（3）血MAGE水平与年龄、糖尿病病程、收缩压呈正相关，与肾小球滤过率、空腹及餐后C肽水平呈负相关。逐步多元回归分析显示糖尿病病程及餐后30minC肽水平与MAGE呈独立相关。（4）MAU组收缩压、舒张压、血尿素氮、血肌酐、血尿酸及MAGE均高于正常白蛋白尿组（均P〈0．05），肾小球滤过率低于正常白蛋白尿组（P〈0．05），Logistic回归分析显示舒张压、MAGE与患者发生MAU独立正相关。结论血糖波动是HbAlc控制理想的2型糖尿病患者发生微量白蛋白尿的危险因素之一，糖尿病病程及早期相胰岛素分泌功能是影响血糖波动水平的主要因素。

Objective To investigate the relationship between the blood glucose variability and microalbuminuria （MAU） in type 2 diabetic patients with well-controlled glycosylated hemoglobin （HbA1 c） and the influencing factors of blood glucose variability. Methods One hundred and seventy-six type 2 diabetic patients with HbAlc under 6.5% and 48 subjects with normal glucose regulation were monitored using the continuous glucose monitoring system （CGMS）. The mean blood glucose （MBG） and mean amplitude of glucose excursions （MAGE） were analyzed. Results （ 1 ） The MBG and MAGE levels of type 2 diabetic patients were （7.0± 0.9） and （3.8 ± 2.5 ） mmol/L respectively, both higher than those of the subjects with normal glucose regulation [ （5.4 ± 0.6） and （2.0 ± 0.7 ） mmol/L respectively, both P 〈 0.01 ]. （2） The incidence ratio of MAU of the patients with ascended MAGE level was 18.7%, significantly higher of those with normal MAGE （7.1%, P 〈 0.05 ）. （3） The MAGE level was positively correlated with age, duration of diabetes, and systolic blood pressure, and negatively correlated with glomerular filtration rate and the levels of fasting and postprandial C-peptide. Multivariant regression analyses indicated that duration of diabetes and the level of postprandial C-peptide 30 min after meal were the independent influential factors of MAGE. （4） In the type 2 diabetic patients, the MAGE of the MAU group was higher than that of the non-MAU group （P 〈 0.05 ）. Logistic regression analyses indicated that diastolic blood pressure and MAGE were the risk factors of MAU （ OR = 1. 201 and 1. 357, both P 〈 0.05 ）. Conclusion In well-controlled patients with type 2 diabetes, blood glucose variability is one of the risk factors for MAU, duration of diabetes and early stage of insulin secretion function are the main factors influencing glycemic variability.