葡萄糖在目标范围内时间与2型糖尿病患者心脏自主神经病变的相关性研究

Relationship between time in rangeand diabetic cardiac autonomic neuropathy in patients with type 2 diabetes

目的研究葡萄糖在目标范围内时间(TIR)与2型糖尿病患者心脏自主神经病变(DCAN)的相关性。方法选取2019年11月至2021年3月在安徽医科大学附属合肥医院内分泌科住院的343例2型糖尿病患者,根据Ewing试验结果将患者分为糖尿病心脏自主神经病变组(DCAN组,n=201)与无糖尿病心脏自主神经病变组(NDCAN组,n=142),比较两组患者临床基本资料及多种指标的差异,采用多因素logistic回归分析DCAN患者的危险因素,通过受试者工作特征(ROC)曲线分析影响因素对DCAN的预测价值。结果DCAN组患者年龄、糖尿病病程、尿白蛋白肌酐比、平均血糖波动幅度(MAGE)、血糖标准差、血糖变异系数、平均血糖水平指标均较NDCAN组患者高,TIR指标较NDCAN组患者低,两组差异有统计学意义(P<0.05)。logistic回归分析显示糖尿病病程、MAGE是DCAN的危险因素(优势比分别为1.055,1.319),TIR是其保护因素(优势比0.963)(P<0.05)。ROC曲线显示,糖尿病病程预测DCAN的曲线下面积(AUC)为0.643,最佳诊断值为4.50年,敏感度和特异度分别为72.60%、53.50%,MAGE预测DCAN的AUC为0.630,最佳诊断值为4.46 mmol/L,敏感度和特异度分别为50.70%、69.00%,TIR预测DCAN的AUC为0.684,最佳诊断值为76.48%,敏感度和特异度分别为71.10%、59.20%(P<0.05)。结论TIR与2型糖尿病患者DCAN发病密切相关,是其保护因素,TIR数据的获取有助于临床上DCAN的风险评估。

Objective To study the relationship between time in range(TIR)and diabetic cardiac autonomic neuropathy(DCAN)in patients with type 2 diabetes mellitus.Methods A total of 343 patients with type 2 diabetes who were hospitalized in the Department of Endocrinology,Hefei Hospital Affiliated to Anhui Medical University from November 2019 to March 2021 were selected.According to the results of Ewing test,the patient s were divided into two groups:diabetic cardiac autonomic neuropathy group(DCAN group,n=201)and non-diabetic cardiac autonomic neuropathy group(NDCAN group,n=142).The differences of clinical basic data and multiple indexes between the two groups were compared.Multivariate Logistic regression was used to analyze the risk factors of DCAN patients.The predictive value of influencing factors to DCAN was analyzed by subject working characteristic(ROC)curve.Results The age,course of diabetes mellitus,UACR,MAGE,SD,CV and MG in DCAN group were higher than those in NDCAN group,while TIR index was lower than that in NDCAN group(P<0.05).Logistic regression analysis showed that the course of diabetes mellitus and MAGE were the risk factors of DCAN(odds ratio 1.055,1.319 respectively),and TIR was the protective factor(odds ratio,0.963).The ROC curve showed that the area under the curve(AUC)of diabetes mellitus course prediction DCAN was 0.643,the critical value was 4.50 years,the sensitivity and specificity was 72.60%and 53.50%,respectively,and the AUC of MAGE prediction DCAN was 0.630,the critical value was 4.46 mmol/L,the sensitivity and specificity was 50.70%and 69.0%,respectively,the AUC of DCAN prediction was 0.684,and the critical value was 76.48%.The sensitivity and specificity was 71.10%and 59.20%respectively(P<0.05).Conclusions TIR is closely related to the incidence of DCAN in patients with type 2 diabetes and is a protective factor.The acquisition of TIR data is helpful to the clinical risk assessment of DCAN.