动态监测老年糖尿病急性冠脉综合征患者急性期血糖波动的变化及意义

Glycemic Excursion in Elderly Diabetics with Acute Coronary Syndrome Revealed by Continuous Glucose Monitoring System and the Significance

目的探讨老年糖尿病患者在急性冠脉综合征(ACS)急性期血糖波动的变化及临床意义。方法连续入选34例老年糖尿病合并ACS患者(ACS组,ACS病程<7d),并选择34例无ACS的老年糖尿病患者做对照(对照组),两组患者性别、年龄及糖化血红蛋白水平进行1∶1配对。用全球急性冠状动脉事件(GRACE)评分评价ACS患者危险度,采用动态血糖监测系统(CGMS)进行连续3d的血糖监测。对两组间各项参数进行比较,并与GRACE评分进行相关性分析。结果 (1)ACS组的日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)和餐后血糖波动幅度(PPGE)明显高于对照组[MAGE(4.02±1.63)和(3.10±0.88)mmol/L,MODD(2.83±1.21)和(2.01±0.97)mmol/L,PPGE(3.35±1.70)和(2.47±1.59)mmol/L,均P<0.05]。(2)在整体研究人群中各因素相关分析显示,胰岛素抵抗指数(HOMA-IR)与各动态血糖参数间均呈正相关,超敏C反应蛋白(hs-CRP)与MAGE、PPGE之间呈正相关,而射血分数(EF值)与MAGE、MODD、PPGE之间呈负相关。(3)在ACS组中以GRACE积分作为因变量,各相关因素作为自变量进行多因素逐步回归分析表明年龄、EF值和MAGE是影响GRACE积分的危险因子。结论老年糖尿病患者在ACS急性期时血糖波动明显增大,而且MAGE的变化有可能影响老年糖尿病ACS患者的临床预后。

Objective To explore the change and clinic significance of glycemic excursion in elderly patients with diabetic mellitus （DM） complicated by acute coronary syndrome（ACS）.Methods Totally 34 elderly DM patients with ACS （ACS group,the course of ACS7d） were enrolled consecutively,and another 34 elderly DM patients were enrolled as control subjects （control group）.The patients in the two groups were all matched for age,sex and glycosylated hemoglobin （HbA1c） levels.The fluctuations of glucose levels in participants were measured by a continuous glucose monitoring system （CGMS） for 3 days.The GRACE risk score was calculated for ACS patients.Results （1） There were significantly higher levels of mean amplitude of glycemic excursions （MAGE）,absolute means of daily differences （MODD） and postprandial glucose excursion （PPGE） in ACS group patients than in control subjects [MAGE： （4.02±1.63） vs.（3.10±0.88） mmol/L,MODD： （2.83±1.21） vs.（2.01±0.97） mmol/L,PPGE： （3.35±1.70） vs.（2.47±1.5） mmol/L,allP0.05].（2） In correlation analysis,the CGMS values were positively correlated with the level of HOMA insulin resistance index （HOMA-IR）,the level of high-sensitive C-reactive protein （hs-CRP） was positively correlated with levels of MAGE and PPGE,and EF value was negatively correlated with the levels of MAGE,MODD,and PPGE.（3） In the ACS group,as GRACE risk score was taken as the dependent variable and the various relative factors as the independent variables,multiple stepwise regression analysis showed that the age,EF value and MAGE were the impact factors of GRACE risk score.Conclusion The blood glucose excursion of elderly DM patients is evidently increased in the acute phase of ACS.The change of MAGE may influence the prognosis of elderly DM patients with ACS.