2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征患者夜间血糖波动增加微血管并发症的风险

Nocturnal blood glucose fluctuation of type 2 diabetes mellitus complicated with obstructive sleep apnea hypopnea syndrome increases the risk of microvascular complications

目的探讨2型糖尿病（T2DM）合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者夜间血糖波动与微血管并发症的关系。方法选择2014年6月至12月我院住院诊断为T2DM合并OSAHS患者55例为病例组，其中男性34例，女性21例，平均年龄（61±6）岁，未合并OSAHS的T2DM患者55例为对照组，其中男性30例，女性25例，平均年龄（60±5）岁。检测血糖、血脂、糖化血红蛋白（HbA1c）、24h尿微量白蛋白（UMA）等相关生化指标。采用动态血糖监测系统（CGMS）监测两组患者平均血糖波动幅度（MAGE）、夜间血糖水平的标准差（SDBG）、日间血糖平均绝对差（MODDl以及最大血糖波动幅度（LAGE）、低血糖时间百分比（〈3．9mmol／L）、高血糖时间百分LL（〉7．8mmol／L）、高血糖时间百分比（〉11．1mmol／L）及血糖波动系数，采用多导睡眠图（PSG）监测睡眠呼吸暂停指数（AHI），并检测患者微血管并发症发生情况。采用t检验、χ2检验、方差分析、Pearson积矩相关分析、Logistic多因素分析进行数据统计。结果（1）随着AHI的增加，其MAGE、SDBG、MODD、LAGE、低血糖时间百分比（〈3．9retool／L）及血糖波动系数也随之增加（F=28．137、26．226、19．802、17．734、29．132、29．404，均P〈0．05）。（2）AHI与MAGE、SDBG及血糖波动系数呈正相关（r=0．465、0．696、0．533，均P〈0．05）。（3）病例组的微血管并发症发生率明显高于对照组，差异有统计学意义（81．8％比32．7％，χ2=27．08，P〈0．05）。（4）Logistic分析显示HbA1c（OR=9．646，95％CI：2．381～39．076）、AHI[7．435（1．834～30．134）1、MAGE[10．052（1．057～95．622）]、SDBG[6．435（1．414-29．287）]、LAGE[12．199（2．322～99．613）]、血糖波动系数[8．511（2．012-35．787）1、糖尿病病程[11．769（3．642～43．005）]是T2DM合并微血管并发症的危险因素。结论合并OSAHS可增加T2DM患者血糖波动幅度及频率，T2DM合并OSAHS患者夜间血糖波动与微血管并发症有关。

Objective To investigate the association between blood glucose fluctuation and mierovascular complications in type 2 diabetes mellitus patients complicated with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods 55 patients（34 males and 21 females,with an average of （61 ±6） years old） complicated with OSAHS were enrolled as case group,and 55 patients （30 males and 25 females, with an average of （60±5）years old） without OSAHS were enrolled as control group.Blood glucose, blood lipid, glycosylated hemoglobin A1c （HbA1c）,and 24 h urinary microalbumin （24 hUMA） was detected. Dynamic glucose monitoring system（CGMS） was used to monitor the values of mean amplitude of glycemic excursions （MAGE）,standard deviation of blood glucose （SDBG）, mean of daily differences （MODD）,largest amplitude of glycemic excursions （LAGE）,the low blood glucose time percentage（〈3.9 mmol/L）, high blood glucose time percentage（〉7.8 mmol/L）, high blood glucose time percentage（〉ll.1 mmol/L） and blood glucose fluctuation coefficient.Apnea hypopnea index （AHI） was monitored by polysomnography （PSG）, microvascular complications of all patients were also detected.t test,χ2 test,variance analysis, Pearson product moment correlation analysis and Logistic multivariate analysis were used to evaluate the data. Results （1）The values of MAGE,SDBG, MODD,LAGE,low blood glucose time percentage（〈3.9 mmol/L） and blood glucose fluctuation coefficient（F=28.137,26.226,19.802,17.734,29.132,29.404,all P〈0.05） were significantly inereased with the inerease of AHI.（2）AHI was positively related with MAGE,SDBG, and blood glucose fluctuation eoeffieient （r=0.465,0.696,0.533,all P〈0.05）. （3） The incidence of microvaseular eomplications in case group （81.8%） was signifieantly higher than that in control group （32.7%, χ2=27.08, P〈0.05）.（4） Logistie analysis showed that HbA1c,（OR=9.646,95%Ch2.381-39.076）, AHI（OR=7.435,95%Chl.834-30.134）, MAGE（OR=10.052, 95%Ch1.057-95.622）, SDBG（OR=6.435,95%Chl.414-29.287）, LAGE（OR=12.199,95% Ch2.322-99.613）,blood glueose fluctuation eoeffieient （OR=8.511,95% Ch2.012-35.787）, the duration of diabetes （OR=11.769,95% Ch 3.642-43.005） was the risk faetor of T2DM compliaced with mierovaseular eomplication. Conclusions The merger of OSAHS could increase blood glueose fluctuation and frequency in T2DM patients.Noeturnal glueose fluctuation was associated with mierovaseular eomplieations in T2DM patients complicated with OSAHS.