2型糖尿病患者随诊间血糖变异性与心、脑血管事件发生的相关分析

Correlation Analysis of Glycemic Variability and the Occurrence of Cardio-cerebrovascular Events in Patients with Type 2 Diabetes Mellitus during the Follow-up Time

目的探讨2型糖尿病患者随诊期间血糖变异性与心、脑血管事件发生的相关性。方法 128例2型糖尿病患者随访30个月,计算随诊期间糖化血红蛋白(hemoglobin A1c,HbA1c)和空腹血糖(fasting plasma glucose,FPG)的标准差和变异系数,并监测心、脑血管事件的发生,包括不稳定型心绞痛、非ST段抬高型心肌梗死、ST段抬高型心肌梗死、缺血性脑卒中和短暂性脑缺血发作(transient ischemic attack,TIA)。结果随诊前基线平均HbA1c(7.62±1.31)%、FPG(7.83±1.22)mmol/L,随诊结束时平均HbA1c(7.13±1.15)%,FPG(7.21±1.24)mmol/L,随诊结束时血糖水平有所下降,血糖达标率明显上升,差异有统计学意义(P<0.01)。随诊期间发生心、脑血管事件共24例,其中,急性冠状动脉综合征16例,缺血性脑卒中3例,TIA 5例。随诊间HbA1c、FPG变异性和平均HbA1c、FPG水平均能够影响心、脑血管事件的发生(P<0.01)。结论随诊间血糖变异性较平均血糖水平更能影响心、脑血管事件的发生,且随诊间血糖变异性对心、脑血管事件发生的影响不依赖于平均血糖水平。

Objective To investigate the correlation of glycemic variability（ GV） and the occurrence of cardio-cerebrovascular events in patients with type 2 diabetes mellitus（ T2DM） during the follow-up time. Methods 128 patients with T2DM were followed for 30-month. The standard deviation and coefficient of variation of hemoglobin A1 c（ Hb A1 c） and fasting plasma glucose（ FPG） during the follow-up time was calculated. And cardio-cerebrovascular events were monitored including unstable angina pectoris,non ST-segment elevation myocardial infarction,ST-segment elevation myocardial infarction,ischemic stroke,and transient ischemic attack（ TIA）. Results Before the follow-up,mean Hb A1 c level was 7. 6 ± 1. 3（ %）,FPG was 7. 8 ±1. 2（ mmol/L）. At the end of the follow-up,mean Hb A1 c level was 7. 1 ± 1. 2（ %）,mean FPG was 7. 2 ± 1. 2（ mmol/L）.The blood glucose level declined at the end of follow-up,while the standard rate of blood glucose was significantly increased.The difference was statistically significant（ P 0. 01）. During the follow-up,24 cases of cardio-cerebrovascular events were found,including acute coronary syndrome（ n = 16）,ischemic stroke（ n = 3）,and TIA（ n = 5）. Both glycemic variability of Hb A1 c,FPG and mean level of Hb A1 c,FPG were correlated with the occurrence of cardio-cerebrovascular events in the follow-up time（ P 0. 01）. Conclusions Glycemic variability are more correlated with the occurrence of cardio-cerebrovascular events than mean blood glucose during the follow-up,and the effect of Glycemic variability on the occurrence of cardio-cerebrovascular events does not depend on mean blood glucose.