冠心病合并初诊2型糖尿病患者的血糖波动及其对血管内皮功能的影响

Glycemic fluctuation and endothelial function in patients of coronary heart disease complicated with type 2 diabetes mellitus

目的探讨冠心病合并初诊2型糖尿病患者的血糖波动及其对血管内皮功能的影响。方法冠心病患者根据口服糖耐量试验结果分为合并糖尿病（观察组，40例）和不合并糖尿病（对照组，18例），两组均行动态血糖监测系统（CGMS）监测及肱动脉血流介导的内皮依赖性舒张功能（FMD）检测。根据CGMS结果，观察组中3倍血糖值S〈平均血糖（MBG）者20例（血糖波动小组），≥MBG者20例（血糖波动大组），分析血糖的波动情况及对FMD的影响。结果①与对照组相比，血糖波动小与大两组日内平均血糖波动幅度（MAGE）、最大血糖波动幅度（LAGE）、平均餐后血糖波动幅度（MPPGE）升高，FMD下降，差异有统计学意义（P〈0．05）。②与血糖波动小组相比，血糖波动大组MAGE、LAGE、MPPGE及13间血糖平均绝对差（MODD）升高[（5．4±0．9）与（3．7±0．4）mmoL／L，（6．3±1．8）与（4．6±0．8）mmoL／L，（4．7±1．0）与（3．5±1．2）mmot／L，（2．45±0．75）与（1．81±0．66）mmol／L]，FMD下降[（3．2±1．0）与（5．2±1．2）％]，差异有统计学意义（均P〈0．05）。③观察组FMD与各血糖波动参数均相关（P〈0．05）；多元线性逐步回归分析显示，MAGE、收缩压是影响FMD的独立因素。结论冠心病合并初诊2型糖尿病患者血糖波动明显增强，FMD明显受损，血糖波动是造成血管FMD损伤的重要因素之一。

Objective To investigate the glycemic fluctuation and endothelial function in patients of coronary heart disease complicated with type 2 diabetes mellitus （T2DM）. Methods Fifty eight patients with coronary heart disease were enrolled in the study, including 40 cases complicated with T2DM （ group A） and 18 cases without T2DM （group B）. All subjects underwent continuous glucose monitoring system （CGMS） and high-resolution ultrasound detection on brachial artery for endothelium-dependent flow- mediated dilatation （FMD）. According to the results of CGMS, patients with 3 times of standard deviation of blood glucose （SDBG） less than a mean blood glucose in group A were classified as low glucose excursion group （group A1 ）, others were classified as high glucose excursion group （group A2）. The association of glucose fluctuation with FMD in group A was analyzed. Results Compared to group B, the levels of mean amplitude of glycemic excursions （ MAGE）, the largest amplitude of glycemic excursions （LAGE） and mean postprandial glucose excursion （MPPGE） were elevated and the levels of FMD were lower in group A1 and A2 （P 〈 0. 05）. Compared to group A1 the levels of MAGE, LAGE, MPPGE and absolute means of daily differences were significantly higher [（5.4 ±0.9） vs. （3.7 ±0.4）, （6.3± 1.8） vs. （4.6 ±0.8）, （4.7±1.0） vs. （3.5±1.2）,（2.45 ±0.75） vs. （1.81 ± 0. 66 ） mmol/L, respectively] and the FMD levels were lower [ （ 3.2 ±1.0） vs. （5.2 ± 1.2 ） % ] in group A2 （ all P 〈 0. 05 ）. All CGMS parameters were significantly correlated with FMD in group A2 （P 〈 0. 05 ）. Multiple stepwise regression analysis showed that MAGE, systolic blood pressure were the independent impact factors of FMD. Conclusions Patients of coronary heart disease complicated with T2DM have prominent glycemie fluctuation and decreased FMD and the glycemic fluctuation may be associated with the impairment of FMD.