血糖漂移对老年2型糖尿病患者血管内皮舒张功能的影响

The effect of glucose excursion on vascular endothelial vasodilatory function in the elderly type 2 diabetic patients

目的探讨动态血糖监测系统（CGMS）监测下控制血糖漂移对老年2型糖尿病患者血管内皮舒张功能的影响。方法（1）选取上海市第六人民医院老年科93例（男61例，女32例）2型糖尿病住院的患者为研究对象。患者入组当天佩戴CGMS，根据监测结果分为两组：血糖高漂移组（59例）和血糖低漂移组（34例）。血糖高漂移组患者继续给予CGMS监测，并根据监测结果及时调整治疗方案，持续治疗4w。疗程结束后再次采血复测相关指标。结果（1）血糖高漂移组患者一氧化氮（NO）浓度低于血糖低漂移组[（36．57±17．08）μmol／L和（60．38±14．21）μmol／L]，差异有统计学意义（t=2．6351，P=0．0017）；（2）血糖高漂移组治疗后血糖漂移指标血糖标准差（SDBG）、最大血糖漂移幅度（LAGE）、平均血糖漂移幅度（MAGE）低于治疗前；（3）血糖高漂移组治疗后血管活性物质NO浓度升高[（36．57±17．08）和（56．83±12．16）]，差异有统计学意义（t=2．5124，P=0．00483）；（4）在血糖高漂移组患者中多因素逐步回归分析显示：NO与SDBG、LAGE呈负相关（β系数分别为-49．9198、-6．8321，P值分别为0．0001、0．0032）。结论CGMS监测下改善血糖漂移能明显改善老年2型糖尿病患者血管内皮舒张功能。

Objective To investigate the improvement in glucose excursion of the elderly type 2 diabetic patients under the continuouse glucose monitoring system monitoring have the effect on vascular endothelial vasodilatory function. Methods Ninety-three elderly type 2 diabetic patients （male 61, female 32） admitted to the department of gerontology, Sixth People＇s Hospital of Shanghai were recruited. All the patients were submitted to CGMS for three days. according to the result of CGMS monitoring, the patients were divided into two groups： high glucose excursion group （59 cases） and low glucose excursion group （34 cases）. In high glucose excursion group, the therapy was adjusted for 4 weeks based on the CGMS mornitoring results. After the treatments, blood samples were collected again to detect the related index. Results （1） The concentration of the Nitrogen monoxide （ NO ） in high glucose excursion group was lower than that of low glucose excursion group （36.57±17.08 vs 60.38±14.2banoL/L, t=2.6351, P=0.0017）. （2） After treatment, the index of glucose excursion such as standard deviation blood glucose （SDBG）, Large amplitude of glycemic excursions （LAGE） and Mean amplitude ofglycemic excursions （MAGE） were decreased in high glucose excursion group. （3） In high glucose excursion group, plasma concentration of NO before treatment was （36.57 ± 17.08 μmol/L）, which increased after 4 weeks treatment （56.83 ± 12.16μmol/L） （t=2.5124, P=0.00483）. （4） Stepwise regression analysis showed that the change of NO was predicted by the change of SDBG （β=-49.9198, P=0.0001）. and LAGE （β=-6.8312, P=0.0032）. Conclusions By CGMS monitoring, the improvement of glucose excursion can ameliorate the damage on vascular endothelial vasodilatory function significantly in the elderly type 2 diabetic patients.