2型糖尿病患者慢性血糖波动对冠脉病变程度影响的观察

Impact of chronic glucose fluctuation on coronary artery disease severity in T2DM patients

目的探索T2DM患者慢性血糖波动对冠脉病变发生发展的影响。方法对35例1周内行过冠脉造影术的T2DM患者根据冠脉造影结果分为合并心血管并发症(13例)与不合并心血管并发症(22例)两组,根据SYNTAX评分系统将合并心血管并发症组的对象进行冠脉病变评分,同时对研究对象行72h动态血糖监测。结果 (1)两组病程、平均血糖波动幅度(MAGE)、血糖标准差(SD)、三餐前后血糖漂移(PPGE1、PPGE2、PPGE3)、夜间低血糖曲线下面积(NAUC)、HbA1c、平均血糖(MBG)差异均有统计学意义(P均<0.05);(2)病程、HbA1c、MBG、PPGE3与冠脉评分无相关性(P>0.05),而MAGE、SD、最大血糖波动幅度(LAGE)、PPGE1、PPGE2、NAUC与冠脉评分有相关性(P<0.05);(3)以冠脉评分为因变量,上述指标为自变量行多重线性回归分析显示,MAGE、SD进入最终方程。结论与慢性高血糖相比,慢性血糖波动对T2DM患者冠脉病变的发生发展可能更具有影响力;早餐及午餐前后血糖漂移可能对冠脉病变的严重程度贡献更大。

Objective To study the impact of chronic glucose fluctuation on the occurrence and development of coronary artery disease in T2DM patients.Methods The 35 T2DM patients who had coronary angiography within the recent one week were divided into 2 groups.There were 13 cases in the cardiovascular complication group and 22 in the non-cardiovascular complication group.The cardiovascular complication group was scored with the lesion-based angiographic SYNTAX scoring system on the severity of coronary artery disease,and at the same time,all the subjects were monitored with the continuous glucose monitoring system(CGMS) for 72 h.Results(1) The course of disease,mean amplitude of glycemic excursions(MAGE),blood glucose standard deviation(SD),postprandial glycemic excursion(PPGE1、PPGE2、PPGE3),area under the curve of night hypoglycemia(NAUC),HbA1c,and mean blood glucose(MBG) were statistically different between the two groups(P<0.05);(2) The course of disease,HbA1c,MBG,and PPGE3 had no correlation with the coronary score(P>0.05),while the MAGE,SD,LAGE,PPGE1,PPGE2,and NAUC were correlated with the coronary score(P<0.05);(3) With coronary score as the dependent variable,the indicators above as independent variables,the multiple linear regression analysis showed that the MAGE and SD came into the final equation.Conclusions Compared with the chronic high glucose,the chronic blood glucose fluctuation is probably more influential factor on the development of coronary artery disease in T2DM patients.PPGE1 and PPGE2 may contribute more to the severity of coronary artery disease than PPGE3.