减少血糖波动对老年糖尿病患者血管内皮功能的影响

Effect of decreased glucose excursion on vascular endothelial function in the elderly type 2 diabetic patients

目的探讨动态血糖监测系统(CGMS)监测下减少血糖波动对老年2型糖尿病患者血管内皮功能的影响。方法在糖化血红蛋白(HbA1c)<7.5%的老年糖尿病患者中行CGMS,根据监测结果,按照血糖标准差(SDBG)≥平均血糖(MBG)定义为血糖波动大,随机选取30例血糖波动大的患者,采用胰岛素泵强化治疗4周,试验结束后再次行CGMS监测。胰岛素泵治疗前后分别测定血一氧化氮(NO)和内皮素(ET)水平并进行比较。结果(1)患者胰岛素泵治疗后血糖波动明显改善;(2)胰岛素泵治疗前NO水平明显低于治疗后[(39.64±19.09)μmol/L比(59.48±16.32)μmol/L](P<0.05),而治疗前ET水平则明显高于治疗后[(117.18±45.03)pg/ml比(72.01±25.21)pg/ml](P<0.05)。(3)多元逐步回归分析显示,NO与SDBG、最大血糖波动幅度(LAGE)和年龄呈负相关(β系数分别为-50.169、-5.882、-1.779,P<0.05);ET与LAGE和年龄呈正相关(β系数分别为7.894、3.767,P<0.05);结论CGMS监测下减少血糖波动能明显改善老年2型糖尿病患者的血管内皮功能。

Objective To investigate the effect of decreased blood glucose excursion on vascular endothelial function in the elderly type 2 diabetic patients. Methods All elderly type 2 diabetic patients with HbA1c〈7.5% underwent continuous glucose monitoring system（CGMS） for three days.According to the results of CGMS,30 patients with a mean blood glucose（MBG） less than 3 times of standard deviation of blood glucose （SDBG） were chosen as high glucose excursion group.They were treated with insulin pump for 4 weeks,and then underwent CGMS for 3 days.Plasma concentration of NO and ET was determined before and after the insulin pump treatment. Results Plasma concentration of NO in diabetic patients before treatment was 39.64±19.09 μmol/L, which was increased significantly after 4 weeks of treatment（59.48±16.32 μmol/L） （P〈0. 05）.ET level in patients before treatment was 117.18±45.03 pg/ml, which was decreased significantly after 4 weeks of treatment （72.01±25.21 pg/ml）（P〈0. 05）. Stepwise regression analysis showed that NO was negatively related to SDBG,LAGE and age（β coefficient=-50.169,-5.882,-1.779, P〈0. 05） and ET was positively related to LAGE and age（β coefficient=7.894,3.767, P〈0. 05）. Conclusions With the CGMS,the decreased glucose excursion in the elderly type 2 diabetic patients can significantly ameliorate the vascular endothelial function.