葡萄糖再灌注对2型糖尿病并发低血糖患者影响的研究

THE EFFECT OF GLUCOSE REPERFUSION ON TYPE 2 DIABETES MELLITUS COMPLICATED WITH HYPOGLYCEMIA

目的观察2型糖尿病患者（DM）并发低血糖后血糖升高至不同水平时生化指标的变化,探讨葡萄糖再灌注对2型糖尿病并发低血糖患者的影响及其影响机制。方法将2012年10月~2014年10月收治的60例2型糖尿病并发中至重度低血糖患者通过随机数字表随机分为A、B组,各30例,两组指尖血糖分别升高至6~8 mmol/L及9~12 mmol/L;选同期随机指尖血糖在6~12 mmol/L 2糖尿病患者35例为对照组（C组）,各组间年龄、ALT、AST、BUN、Cr差异无统计学意义,A、B两组基线血糖、CK、CK-MB、Cys C、CRP差异无统计学意义。比较A、B组升糖前后及C组生化指标和CRP的变化。结果 A组升糖后的CK、CK-MB较升糖前显著降低（p〈0.05）,B组升糖后CK、CK-MB较A组升糖后显著升高（p〈0.05）;C组CK、CK-MB较A、B组升糖前显著降低（p〈0.05）;A组升糖后的Cys C、CRP较升糖前差异无显著性（p〉0.05）,B组升糖后的Cys C、CRP较升糖前及A组升糖后显著性升高（p〈0.05）;C组Cys C、CRP较B组升糖后显著下降（p〈0.05）,三组总体CRP与血糖（r=0.395,p〈0.01）、Cys C（r=0.365,p〈0.01）呈正相关。结论 2型糖尿病并发低血糖患者葡萄糖升至较高水平时不利于心肌损伤修复,并引起早期肾损害,提示存在葡萄糖再灌注损伤;炎症因子CRP与葡萄糖再灌注损伤相关。

Objective To observe the changes of biochemical indexes of type 2 diabetic patients with hypoglycemia after rising glucose to different levels,and to investigate the effects and its mechanism of glucose reperfusion. Methods 60 cases of patients with type 2 diabetes mellitus complicated with moderate to severe hypoglycemia in our hospital were randomly divided into group A and B with 30 cases in each. Fingertip blood glucose were increased to 6 ~ 8 mmol / L and 9 ~ 12 mmol / L; 35 cases of type 2 diabetic patients with fingertip blood glucose at 6 ~12 mmol / L were randomly selected as the control group（ group C）. There were no statistically significant differences at age,AST,BUN and Cr between the groups. The baseline glucose,CK,CK- MB,Cys C and CRP of groups A and B had no significant difference. The changes of biochemical glycemic index and CRP of group A and B were then compared. Results CK and CK- MB of group A decreased significantly after rising glucose（ p 〈 0. 05）,CK and CK- MB of group B increased significantly after rising glucose compared with group A（ p 〈 0. 05）; CK and CK- MB of group C decreased significantly compared with group A and B before rising glucose（ p 〈 0. 05）; Cys C and CRP of group A had no significant difference before and after rising glucose（ P 〉 0. 05）,Cys C and CRP of group B increased significantly after rising glucose and compared with group A（ p 〈 0. 05）; Cys C and CRP of group C decreased significantly compared with group B after rising glucose（ p 〈 0. 05）. CRP and blood glucose（ r = 0. 395,p 〈 0. 01）,Cys C（ r = 0. 365,p 〈 0. 01） of the three groups were positively correlated. Conclusion The relatively high level of glucose in type 2 diabetic patients with hypoglycemia is not conducive to cardiac repair,and may lead to early renal damage,suggesting the presence of glucose reperfusion injury; CRP relates with glucose reperfusion injury.