2型糖尿病合并急性冠状动脉综合征患者急性期血糖变异性与冠状动脉狭窄程度的关系

Relationship between acute phase blood glucose fluctuation and coronary artery stenosis in patients with type 2 diabetes mellitus and acute coronary syndrome

目的探讨2型糖尿病合并急性冠状动脉综合征（ACS）患者急性期血糖变异性与冠状动脉狭窄程度的相关性。方法2010年11月至2011年10月在北京军区总医院心内科住院的2型糖尿病合并ACS患者64例，其中行急诊冠状动脉造影术30例（A组），男19例，女11例，年龄（60±11）岁；择期冠状动脉造影术34例（B组），男15例，女19例，年龄（59±10）岁，择期冠脉造影术均在患者病情稳定1周左右进行；同期住院的20例不合并ACS的2型糖尿病患者为对照组，男12例，女8例，年龄（54±13岁）。应用动态血糖监测仪对3组患者进行连续72h的血糖监测，比较3组患者间血糖波动参数，分析各组血糖波动参数及临床生化指标与冠状动脉狭窄程度（Gensini积分）的相关性。组间比较采用方差分析，相关性分析采用Pearson相关和多元逐步回归分析，P〈0．05为差异有统计学意义。结果与对照组日内血糖波动幅度（MAGE）、餐后血糖波动幅度（MPPGE）[（5．6±1．5）、（2．5±1．0）mmol／L]相比，A组[（7．2±2．2）、（3．3±1．1）mmol／L]和B组[（6．2±4．4）、（3．2±1．4）mmol／L]均显著增高，差异均有统计学意义（F=8．543、3．465，均P〈0．05）。最大血糖波动幅度（LAGE）、MAGE、日间血糖波动幅度（MODD）、MPPGE、胰岛素抵抗指数（HOMA—IR）、C反应蛋白与Gensini积分呈明显正相关（r=0．463、0．439、0．633、0．595、0．282、0．224，均P〈0．05），左心室射血分数（LVEF）与Gensini积分呈负相关（r=-0．579，P〈0．01）。多因素逐步回归分析发现：MODD、LVEF、MPPGE均与Gensini积分独立相关（Y=388．629＋33．794MODD-93．824LVEF＋8．531MPPGE）。结论2型糖尿病患者在ACS急性期血糖变异性明显增大，血糖波动幅度与冠状动脉狭窄程度呈正相关，其中日间和餐后血糖变异性为独立相关因素。

Objective To investigate the change of glucose variability and the relationship between glucose variability and the severity of coronary artery stenosis in patients with type 2 diabetes mellitus （T2DM） with acute coronary syndrome（ACS）. Methods A total of 64 hospitalized patients with T2DM and ACS were recruited from November 2010 to October 2011. Thirty eases（ 19 males and 11 females, aged （60 ± 11 ） yrs） underwent emergency coronary angiography （ group A） , and 34 cases（ 15 males and 19 females, aged （59± 10） yrs） in stable condition underwent selective coronary angiography after one week （group B）. Twenty T2DM cases without ACS in the same period were set as control group（ 12 males and 8 females, aged （54 ± 13）yrs）. All the participants underwent continuous glucose monitoring （CGM） for 72 hours to evaluate CGMS parameters such as largest amplitude of blood glucose excursion （ LAGE）, mean amplitude of glycemic excursions（MAGE）, standard deviation of blood glucose（SDBG） , absolute means of daily differences （MODD）, postprandial glucose excursion （MPPGE）, the mean postprandial maximumglucose（MPMG）. The correlation was analyzed between the parameters and clinical biochemical and the severity of coronary artery stenosis （Gensini score）in T2DM patients with ACS. The measurement data of multiple groups were compared with single factor analysis of variance, and the comparison between two groups was performed with LSD test, correlation analysis with Pearson correlation and multiple stepwise regression analysis. Results Compared with control group （ （ 5.6 ± 1.5 ） , （2. 5 ± 1.0） mmol/L） , the levels of MAGE and MPPGE in group A（ （7.2 ±2. 2） , （3.3 ± 1.1 ） retool/L） and group B （ （6. 2 ±4. d） , （3.2 ± 1.4） mmol/L） were higher （ F = 8. 543, 3. 465, all P 〈 0. 05 ）. LAGE, MAGE, MODD, MPPGE, homeostatic model assessment-insulin resistance （HOMA-IR）, C-reactive protein （CRP）were positively related to Gensini score （ r = 0. 463, 0. 439, 0. 633, 0. 595, 0. 282, 0. 224, all P 〈 0. 05 ）, while left ventricular ejection fraction （LVEF） were negatively related to Gensini score （ r = - 0. 579, P 〈 0. 01 ）. Multiple stepwise regression analysis indicated that MODD, LVEF and MPPGE were dependent risk to Gensini score （ Y = 388. 629 ± 33. 794MODD - 93. 824 LVEF ± 8.531MPPGE ）. Conclusions Glucose variability of the patients with type 2 diabetes increases obviously in the acute phase of ACS. MODD and MPPGE were dependent positively correlated to the severity of coronary artery stenosis in patients with T2DM and ACS.