2型糖尿病患者血糖波动与泌汗功能的相关性

Correlation between giycemic variability and sudomotor function in patients with type 2 diabetes

目的探讨2型糖尿病（T2DM）患者血糖波动与泌汗功能之间的相关性。方法选取2016年3月至2017年5月于解放军南京总医院内分泌科就诊的395例T2DM患者为研究对象，根据电导分析仪SUDOSCAN测得的电化学皮肤电导率（ESC）将患者分为两组：手和足ESC均〉60 μs为泌汗功能正常组（221例，其中男144例，女77例），手或足ESC≤60 μs则为泌汗功能异常组（174例，其中男104例，女70例）。所有患者均使用持续葡萄糖监测系统连续监测72 h，并记录临床及生化指标。比较两组间临床生化指标及血糖波动参数，并进行Spearman相关分析及多元逐步线性回归分析。结果（1）与泌汗功能正常组相比，泌汗功能异常组年龄更大[（59±12）比（52±13）岁，t=-5.252，P〈0.001]、糖尿病病程更长[10（5，16）比4（1，10）年，Z=-6.152，P〈0.001]，肌酐水平更高[60（47，76）比52（42，63）μmol/L，Z=-4.175，P〈0.001]。（2）泌汗功能异常组平均血糖波动幅度（MAGE）、日间血糖平均绝对差等血糖波动参数均高于泌汗功能正常组[分别为（6.3±2.2）比（5.7±1.7）mmol/L、（2.8±1.5）比（2.4±1.4）mmol/L，t=-3.050、-2.381，均P〈0.05]。（3）Spearman相关性分析显示，手、足ESC平均值、手、足平均不对称与血糖波动各参数的相关性在糖化血红蛋白（HbA1c）〈8.0%亚组普遍大于8.0%≤HbA1c ≤9.6%亚组和HbA1c〉9.6%亚组（r值范围分别为0.058-0.368比0.003-0.282、0.007-0.237），男性普遍大于女性组（r值范围分别为0.023-0.215比0.003-0.219，均P〈0.05）。（4）多元逐步线性回归分析显示，MAGE、糖尿病病程、肌酐是影响泌汗功能的独立危险因素（B=-1.550、-0.758、-0.118,均P〈0.05）。结论MAGE、糖尿病病程、肌酐是T2DM患者泌汗障碍的独立危险因素；男性以及HbA1c控制相对较好时，血糖波动对泌汗功能的影响作用更大。

ObjectiveTo investigate the correlation between glycemic variability and sudomotor function in patients with type 2 diabetes mellitus （T2DM）.MethodsA total of 395 cases with T2DM in the Department of Endocrinology, Nanjing General Hospital of the PLA from March 2016 to May 2017 were enrolled. According to the electrical skin conductivities （ESC） of hands and feet measured with SUDOSCAN, a conductance analyzer, the patients were divided into two groups： 221 cases with normal sudomotor function （normal group, both ESC of hands and feet 〉60 μs, including 144 males, 77 females） and 174 cases with abnormal sudomotor function （abnormal group, ESC of hands or feet ≤60 μs, including 104 males and 70 females）. All participants were monitored with the continuous glucose monitoring system for consecutive 72 hours. Clinical and biochemical indexes were recorded. Biochemical indexes and glycemic variability parameters were compared between the two groups. Spearman correlation analysis and the multiple linear regression analysis were adopted for statistical analysis.Results（1） Compared with the normal sudomotor function group, the abnormal group were with older age [（59±12） vs （52±13） yrs, t=-5.252, P〈0.001], longer diabetic duration [10（5, 16） vs 4（1, 10） yrs, Z=-6.152, P〈0.001] and higher level of creatinine [60（47, 76） vs 52（42, 63） μmol/L, Z=-4.175, P〈0.001]. （2） The parameters of glycemic variability, such as mean amplitude of glycemic excursions （MAGE） and mean of daily differences in abnormal group were higher than those in the normal group [（6.3±2.2） vs （5.7±1.7） mmol/L, （2.8±1.5） vs （2.4±1.4） mmol/L, t=-3.050, -2.381, both P〈0.05]. （3） Spearman correlation analysis showed that the correlation coefficient between hands ESC, feet ESC, hand mean asymmetry, foot mean asymmetry and the parameters of glucose variability in glycated hemoglobin A1c （HbA1c） 〈8.0% subgroup were generally higher than those in 8.0%≤HbA1c≤9.6% subgroup and HbA1c〉9.6% subgroup （r value： 0.058-0.368 vs 0.003-0.282, 0.007-0.237）. The correlation coefficients between HESC, FESC, hand mean asymmetry, foot mean asymmetry and glycemic variability parameters were generally larger in male group than those in female group （r value： 0.023-0.215 vs 0.003-0.219）. （4） Stepwise multiple linear regression analysis revealed that MAGE, duration of disease and creatinine were the independent risk factors affecting sudomotor function （B=-1.550, -0.758, -0.118, all P〈0.05）.ConclusionMAGE, duration of disease and creatinine are the independent risk factors affecting sudomotor function in patients with T2DM. Glycemic variability are more likely to affect the sudomotor function in male patients and patients with lower level of HbA1c.