血糖波动与氧化应激对2型糖尿病微血管病变的影响

Effect of blood glucose fluctuation and oxidative stress on microangiopathy in type 2 diabetes mellitus patients

目的探讨血糖波动与氧化应激对2型糖尿病微血管病变的关系。方法选择2型糖尿病患者109例,根据尿白蛋白排泄率(UAER)分为3组:正常白蛋白尿组(A组)、微量白蛋白尿组(B组)和大量白蛋白尿组(C组)。健康体检者30例为对照组。糖尿病患者给予胰岛素治疗12周,检测干预前后血压、空腹血糖(FPG)、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、血脂、糖化血红蛋白(HbA1c)、平均血糖波动幅度(MAGE)、超氧化物歧化酶(SOD)、丙二醛和UAER。结果胰岛素干预后,A组、B组和C组FPG、HbA1c、HOMA-IR、TG较治疗前明显下降(P<0.05);B组和C组SOD较治疗前明显增高,丙二醛、UAER、MAGE较治疗前明显下降(P<0.05,P<0.01)。MAGE与HOMA-IR、UAER、丙二醛呈正相关,与SOD呈负相关(P<0.05,P<0.01);logistic回归分析显示,年龄、病程、收缩压、HbA1c、HOMA-IR、MAGE、丙二醛是导致2型糖尿病患者蛋白尿严重程度的独立危险因素,SOD是保护因素。结论血糖波动与体内氧化应激密切相关,氧化应激参与糖尿病微血管病变的发生、发展。

Objective To study the effect of blood glucose fluctuation and oxidative stress on microangiopathy in type 2 diabetes mellitus （T2DM） patients.Methods One hundred and nine T2DM patients were divided into normal albuminuria group（group A）,microalbuminuria group （group B） and macroalbuminuria group （group C） according to their UAER,and 30 healthy subjects served as a control group in this study.The patients in groups A-C were treated with insulin for 12 weeks.Their BP,FPG,fasting insulin,insulin resistance index （IRI）,blood lipid,HbA1c,MAGE,SOD,MDA and UAER were measured before and after insulin treatment.Results The serum FPG,HbA1c,TG levels and IRI were significantly lower in groups A-C after insulin treatment than before insulin treatment.The serum FPG,HbA1c,TG levels and IRI were significantly higher whereas the serum MDA level and the MACE,UAER were significantly lower in groups B and C after SOD treatment than before SOD treatment.MAGE was positively related with IRI,UAER,MDA and negatively related with SOD （P＜0.05,P＜0.01）.Logistic regression analysis showed that age,course of disease,SBP,HbA1c,IRI,MAGE,MDA were the independent risk factors for severe albuminuria in T2DM patients while SOD was its protective factor.Conclusion Blood glucose fluctuation is closely related with in vivo oxidative stress which participates in the development and progression of diabetic microangiopathy.