老年2型糖尿病患者血糖变异性与糖尿病肾病的关系

Association of glycemic variability and severity of diabetic nephropathy in elderly patients with type 2 diabetes

目的:研究老年2型糖尿病患者血糖变异性与糖尿病肾病的关系。方法:对114例老年2型糖尿病患者按照24h尿微量白蛋白量分为:单纯糖尿病组(DM组)36例,早期糖尿病肾病组(EDN组)44例,临床糖尿病肾病组(DN组)34例。检测收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、糖化血红蛋白(HbA1C)、血肌酐(sCr)、半胱氨酸蛋白酶抑制剂C(CysC),并采用动态血糖监测系统(CGMS)计算日内平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、全天血糖值标准差(SDBG)、曲线下面积(AUC)和日间血糖平均绝对差(MODD)来评价血糖变异性。结果:DN组SBP、DBP、HbA1C、sCr和CysC显著高于EDN组和DM组(P<0.05)。EDN组CysC显著高于DM组(P<0.05)。DN组SDBG、MAGE、LAGE、AUC、MODD显著高于EDN组和DM组(P<0.05),日内及日间血糖波动幅度显著增加,EDN组的CGMS各项指标均显著高于DM组(P<0.05)。结论:老年2型糖尿病患者血糖变异性与DN的发生、发展及严重程度有着密切关系。

Objective To investigate association of glycemic variability and severity of diabetic nephropathy in elderly patients with type 2 diabetes. Methods One hundred and fourteen elderly patients with type 2 diabetes were enrolled and divided into 3 groups according to 24 h urinary albumin excretion rate. The 3 groups are as follows： the diabetes group （DM, n = 36）, the early diabetic nephropathy group（EDN, n = 44） and the clinical diabetic nephropathy group （DN, n = 34）. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, fasting blood sugar（FBG）, hemoglobin Alc（HbAlc）, serum creatinine （Scr）, serum cystatin C （Cys C） were determined, and blood glucose level was monitored with continuous glucose monitor system （CGMS）. The standard deviation of mean blood glucose （SDBG）, the mean amplitude of glycemic excursions （MAGE）, the largest amplitude of glycemic excursions （LAGE）, the area under curve （AUC） and the absolute means of daily differences （MODD） were also calculated. Results SBP, DBP, HbAlc, sCr and Cys C of DN group were significantly increased than those in the EDN and in the DM groups （P 〈 0.05）, Cys C in the EDN group was significantly higher than that in the DM group （P 〈 0.05）, levels of the SDBG, MAGE, LAGE, AUC and MODD were significantly higher in the DN group than those in the EDN and in the DM groups （P 〈 0.05）, every index of CGMS in the EDN group increased significantly compared with that in the DM group （P 〈 0.05 ）. Conclusions Glycemic variability has a close relationship with the presence, development and severity of DN in elderly patients with type 2 diabetes.