血糖变异性在2型糖尿病合并冠心病中的特征及与冠状动脉狭窄程度的关系分析

Correlation between glucose variability and coronary stenosis in type 2 diabetes mellitus combined with coronary heart disease patients

目的 探讨2型糖尿病合并冠心病患者血糖变异性与冠状动脉狭窄程度的相关性.方法 选择行冠状动脉造影术的2型糖尿病患者80例为研究对象,据冠状动脉造影结果,48例2型糖尿病合并冠心病患者为冠心病组,32例2型糖尿病不合并冠心病患者作为对照组.入院后均行72 h动态血糖监测,计算平均血糖（MBG）、血糖水平标准差（SDBG）、日内平均血糖波动幅度（MAGE）、日间血糖平均绝对差（MODD）、最大血糖波动幅度（LAGE）、平均餐后血糖漂移幅度（MPPGE）,并分析冠状动脉狭窄程度（以Gensini评分表示）的危险因素.结果 冠心病组LAGE、SDBG、MAGE、MPPGE、MODD显著高于对照组[（11.4±3.6） mmol/L比（8.2±1.9） mmol/L、（3.4±1.4）mmol/L比（1.9±0.6） mmol/L、（7.1 ±2.7） mmol/L比（4.8±1.4） mmol/L、（6.6±1.8） mmol/L比（4.6±1.5） mmol/L、（3.3±1.2） mmol/L比（2.5±0.9） mmol/L],差异有统计学意义（P＜0.05）,两组MBG比较差异无统计学意义[（10.2±2.8） mmol/L比（9.3±2.2） mmol/L]（P＞ 0.05）.Pearson相关分析显示,MPPGE、MODD、LAGE与Gensini评分呈正相关（r=0.509,0.357和0.338;P＜ 0.05）;LVEF与Gensini评分呈负相关（r=-0.372,P＜0.05）.结论 2型糖尿病合并冠心病患者血糖变异性明显增大,MPPGE、MODD和LAGE与冠状动脉狭窄程度呈正相关.

Objective To investigate the correlation between glucose variability and coronary stenosis in type 2 diabetes mellitus （T2DM） combined with coronary heart disease （CHD） patients.Methods Eighty patients with T2DM who had undergone coronary angiography were selected.According to the result of coronary angiography,the patients were divided into 2 groups：48 T2DM combined with CHD patients as CHD group,and 32 T2DM combined without CHD patients as control group.All patients underwent continuous glucose monitoring （CGM） for 72 h,and the mean blood glucose （MBG）,standard deviation of blood glucose （SDBG）,daily mean amplitude of glycemic excursion （MAGE）,absolute means of daily differences （MODD）,largest amplitude of blood glucose excursion （LAGE） and mean postprandial glucose excursion （MPPGE） were computed.The risk factor of coronary stenosis （using Gensini score） was analyzed.Results The LAGE,SDBG,MAGE,MPPGE,MODD in CHD group were significantly higher than those in control group：（11.4 ± 3.6） mmol/L vs.（8.2 ± 1.9） mmol/L,（3.4 ± 1.4） mmol/L vs.（1.9 ± 0.6） mmol/L,（7.1 ± 2.7） mmol/L vs.（4.8 ± 1.4） mmol/L,（6.6 ± 1.8） mmol/L vs.（4.6 ± 1.5） mmol/L,（3.3 ± 1.2） mmol/L vs.（2.5 ± 0.9） mmol/L,and there were statistical differences （P 〈 0.05）.There was no statistical difference in MBG between CHD group and control group：（10.2 ± 2.8） mmol/L vs.（9.3 ± 2.2） mmol/L,P 〉 0.05.The Pearson correlation analysis result showed that the MPPGE,MODD and LAGE had positive correlation with Gensini score （r =0.509,0.357 and 0.338;P 〈 0.05）;and the LVEF had negative correlation with Gensini score （r =-0.372,P 〈 0.05）.Conclusions Glucose variability in patients with T2DM combined with CHD is markedly enhanced.MPPGE,MODD and IAGE are positively correlated with the severity of coronary stenosis.