2型糖尿病餐后高血糖状态与血管病变关系的研究

Relationship between postprandial hyperglycemia state and vascular complications in type 2 diabetes

目的:探讨2型糖尿病患者单纯餐后高血糖状态对大小血管并发症的影响。方法:149例2型糖尿病患者分为2组:单纯餐后血糖（PPG）增高组（Ⅰ组,50例,FPG<7.0 mmol/L）、空腹血糖（FPG）及PPG均增高组（Ⅱ组,99例,FPG≥7.0mmol/L）。正常对照组35例。测定研究对象的PPG、空腹胰岛素（FINS）、2hPPG、餐后2小时胰岛素（2hINS）、总胆固醇（TC）、甘抽三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、糖基化血红蛋白（HbA1c）,计算胰岛素敏感性指数,并分析其大小血管并发症的发生情况。结果:Ⅰ组微血管并发症发生率低于Ⅱ组（14.3％:64.4％,P<0.01）;而两组间大血管并发症发生率无显著差异（59.2％:47.1％,P>0.05）。Ⅰ组和Ⅱ组的糖尿病病程分别为1.47±1.07年,7.13±5.75年,两组有显著差异（P<0.01）。两组的胰岛素敏感指数（IAI）与对照组比较均显著降低（P均<0.01）,而Ⅱ组的IAI又较Ⅰ组显著降低（P<0.01）.结论:2型糖尿病在其早期存在单纯餐后高血糖状态,此时胰岛素敏感性已降低。此期虽然糖尿病病程较短,空腹血糖不高,微血管并发症较少,但大血管并发症发生率与FPG及PPG均增高的患者基本相当。

Objective:To study the relationship between postprandial hyperglycemia and vascular complications in type 2 diabetes. Methods: One hundred and forty-nine patients with type 2 diabetes were divided into two test groups, group Ⅰ including 50 patients, there was only PPG increased (FPG<7. 0 mmol/L) and groupⅡ including 99 patients, both FPG and PPG increased (FPG≥7.0mmol/L). The clinical data such as FPG, FINS, 2hPPG, 2hINS, TC, TG, HDL, LDL, HbAlc and IAI were observed in 35 control subjects and 2 test groups. Diabetic vascular complications were estimated in 2 test groups. Results: There was no significant difference between 2 test groups in the incidence of macrovascular complications (59.2% vs 47.1 %, P > 0. 05 ) . the incidence of microvascular complications was lower (14. 3% vs 64. 4%, P<0. 01) in group Ⅰ compared with that in group Ⅱ . IAI of 2 groups with diabetes were less than that of control group (P<0. 01). Conclusion: These results suggest that postprandial hyperglycemia state exist in early type 2 diabetes with decrease of insulin sensitivity. Despite of shorter duration of diabetes, lower FPG and less incidence of microangiopathy in patients with postprandial hyperglycemia, it macrovascular complications are as severe as patients both with fasting and postprandial hyperglycemia.