葡萄糖范围内时间和平均血糖波动幅度与早期糖尿病肾病相关性的研究

Correlation of Time in Glucose Range and Average Blood Glucose Fluctua⁃tion Amplitude with Early Diabetic Nephropathy

目的探讨T2DM患者葡萄糖范围内时间(TIR)和平均血糖波动幅度(MAGE)与糖尿病肾病(DKD)的相关性。方法随机选取2018年1月—2021年3月在该院就诊住院的2型糖尿病(T2DM)患者110例,根据尿微量白蛋白/肌酐比值(UMA/Cr)分为正常白蛋白尿组(NA组,n=35)和微量白蛋白尿组(MIA组,n=75),比较两组TIR、MAGE、平均血糖(MBG)、血糖变异系数(CV)、血糖标准差(SDBG)、血清肌酐(Cre)、尿酸(UA)、总胆固醇(TC)、三酰甘油(TG)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、高密度脂蛋白胆固醇(HLD-C)和低密度脂蛋白胆固醇(LDL-C)及糖化血红蛋白(HbA1c)的差异,并进行Spearman相关分析。结果MIA组Cre(77.48±20.56)mmol/L、TC(5.36±1.01)mmol/L、TG(2.54±1.13)mmol/L、LDL-C(2.94±1.20)mmol/L、UA(295.62±66.94)mmol/L、UMA/Cr(110.43±25.45)μg/mg均高于NA组(68.59±17.84)mmol/L、(4.76±0.87)mmol/L、(1.87±0.87)mmol/L、(2.35±1.08)mmol/L、(263.34±56.70)mmol/L、(20.45±6.83)μg/mg,差异有统计学意义(t=2.199、3.027、3.102、2.477、2.468、-28.498,P<0.05);MIA组TIR(0.64±0.16)%明显低于NA组(0.85±0.19)%,差异有统计学意义(t=6.033,P<0.05)。MIA组MAGE(7.32±1.95)mmol/L、MBG(9.41±1.87)mmol/L、SDBG(2.56±0.85)mmol/L、CV(26.19±8.12)%均高于NA组(4.23±1.67)mmol/L、(8.34±1.59)mmol/L、(1.83±0.69)mmol/L、(20.65±6.87)%,差异有统计学意义(t=8.087、2.925、4.440、3.492,P<0.05)。Spearman相关分析显示,MAGE(r=0.237,P=0.012)与DKD呈正相关,而TIR(r=-0.248,P=0.009)与DKD呈负相关。结论TIR水平越高,MAGE水平越低,提示血糖控制越好,可有效降低DKD的风险。

Objective To investigate the correlation of time in glucose range(TIR)and mean amplitude of glucose ex⁃cursion(MAGE)with diabetic nephropathy(DKD)in patients with T2DM.Methods A total of 110 patients with type 2 diabetes mellitus(T2DM)who were admitted to the hospital from January 2018 to March 2021 were randomly se⁃lected.According to the urine microalbumin/creatinine ratio(UMA/Cr),they were classified as normoalbuminuria group(NA group,n=35),microalbuminuria group(MIA group,n=75).TIR,MAGE,mean blood glucose(MBG),blood glucose coefficient of variation(CV),standard deviation of blood glucose(SDBG),serum creatinine(Cre),uric acid(UA),total cholesterol(TC),triacylglycerol(TG),fasting blood glucose(FPG),2 h postprandial blood glucose(2 hPG),high-density lipoprotein cholesterol(HLD-C),low-density lipoprotein cholesterol(LDL-C)and glycosylated hemo⁃globin(HbA1c)were compared between the two groups,and Spearman correlation analysis was performed.Results Cre(77.48±20.56)mmol/L,TC(5.36±1.01)mmol/L,TG(2.54±1.13)mmol/L,LDL-C(2.94±1.20)mmol/L,UA(295.62±66.94)mmol/L,UMA/Cr(110.43±25.45)μg/mg in the MIA group were higher than NA group(68.59±17.84)mmol/L,(4.76±0.87)mmol/L,(1.87±0.87)mmol/L,(2.35±1.08)mmol/L,(263.34±56.7)mmol/L,(20.45±6.83)μg/mg,the dif⁃ference was statistically significant(t=2.199,3.027,3.102,2.477,2.468,-28.498,P<0.05).The TIR(0.64±0.16)%of the MIA group was significantly lower than that of the NA group(0.85±0.19)%,and the difference was statistically significant(t=6.033,P<0.05).MAGE(7.32±1.95)mmol/L,MBG(9.41±1.87)mmol/L,SDBG(2.56±0.85)mmol/L,CV(26.19±8.12)%in the MIA group were higher than NA group(4.23±1.67)mmol/L,(8.34±1.59)mmol/L,(1.83±0.69)mmol/L,(20.65±6.87)%,the difference was statistically significant(t=8.087,2.925,4.440,3.492,P<0.05).Spearman correlation analysis showed that spearman correlation analysis showed that mage(r=0.237,P=0.012)was positively correlated with DKD,while TIR(r=-0.248,P=0.009)was negatively correlated with DKD.Conclusion The higher the TIR level,the lower the MAGE level,indicating better blood glucose control,which can effectively reduce the risk of DKD.