血糖变异对老年T2DM合并ACS患者内皮功能和MACE的影响

Effect of glycemic variability on endothelial function and MACE in older patients with type 2 diabetic mellitus complicated with acute coronary syndrome

目的探讨血糖变异对老年2型糖尿病(T2DM)合并急性冠状动脉综合征(ACS)患者内皮功能和主要不良心血管事件(MACE)的影响。方法选择109例老年ACS患者,按是否合并T2DM分为T2DM组与非T2DM组,按有无MACE分为MACE组与无MACE组。记录空腹血糖(FBG)、糖化血红蛋白(HbA1c)和入院后MACE。辅理善瞬感扫描式血糖监测系统检测最大血糖波动幅度(LAGE)、日内血糖波动幅度(MAGE)、日内血糖绝对差(MODD)、餐后血糖波动幅度(PPGE)。ELISA法检测血清内皮型一氧化氮合酶(eNOS),冠状动脉造影(CAG)检查血管病变特点,进行冠状动脉Gensini评分。结果与非T2DM组比较,T2DM组MODD、PPGE、LAGE、MAGE、FBG、HbA1c增高,eNOS水平降低,血管单、双支病变和轻中度病变较少,多支病变及重度病变较多,Gensini评分较高。与无MACE组比较,MACE组Gensini评分、LAGE、MAGE、MODD、PPGE升高,eNOS水平降低。Logistic回归显示,LAGE、MAGE、eNOS和Gensini评分是老年T2DM合并ACS患者MACE的独立危险因素;ROC曲线分析显示,LAGE和MAGE对该类患者MACE有预测价值。结论LAGE和MAGE是老年T2DM合并ACS患者MACE的危险因素,减少血糖变异可能通过改善内皮功能降低其MACE的发生。

Aim To investigate the effect of glycemic variabilityon endothelial function and major adverse cardiovascular events(MACE)in older type 2 diabetes mellitus(T2 DM)patients complicated with acute coronary syndrome(ACS).Methods 109 older patients with ACS were divided into T2 DM group and non-T2 DM group according to with or without T2 DM,and MACE group and non-MACE group according to with or without MACE.Fasting blood glucose(FBG),glycosylated hemoglobin(HbA1 c)and MACE after admission were recorded.Maximum blood glucose fluctuation range(LAGE),intra-day blood glucose fluctuation range(MAGE),intra-day blood glucose absolute difference(MODD)and postprandial blood glucose fluctuation range(PPGE)were detected by fulishan transient tracing glucose monitoring system.Serum endothelial nitric oxide synthase(eNOS)was detected by ELISA.Coronary angiography(CAG)was performed to assess vascular characteristics and coronary artery score(Gensini score).Results Compared with non-T2 DM group,FBG and HbA1 c increased and eNOS level decreased inT2 DM group.Fewer single-vessel lesions and mild lesions,more multi-vessel lesions,severe and occlusions lesions,and higher Gensini score were also dected in T2 DM group.Compared with non-MACE group,Gensini score,LAGE,MAGE and MODD were increased and eNOS level was decreased in MACE group.Multi-Logistic regression analysis indicated that LAGE,MAGE,eNOS and Gensini scores were independent risk factors for MACE in older patients with T2 DM complicated with ACS,ROC curve analysis showed that LAGE and MAGE had predictive value for MACE in those patients.Conclusions LAGE and MAGE are risk factors for MACE in older patients with T2 DM complicated with ACS,reducing glycemic variability may reduce MACE in those patients by improving endothelial function.