血糖波动与2型糖尿病肾病的相关性研究

Study on the correlation between blood glucose fluctuation and type 2 diabetic nephropathy

目的 探讨2型糖尿病患者血糖波动与糖尿病肾病的相关性。方法 选取2021年5月~12月就诊于首都医科大学大兴教学医院的2型糖尿病患者338例,根据有无糖尿病肾病分为糖尿病肾病组(DN1组)和糖尿病非肾病组(DN0组),每组各169例。所有患者均检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹C肽、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA)、尿白蛋白/肌酐比值(UACR)、肌酐、肾小球滤过率(eGFR)。并行动态血糖监测,采集平均血糖(MBG)、血糖水平标准差(SDBG)、平均血糖波动幅度(MAGE)。结果 糖尿病肾病组与糖尿病非肾病组的FPG、HbA1c、空腹C肽、TG、LDL-C、HDL-C、UA相比较,差异均无统计学意义(P> 0.05)。糖尿病肾病组的UACR及肌酐均明显高于糖尿病非肾病组,肾小球滤过率(eGFR)明显低于糖尿病非肾病组,差异有统计学意义(P <0.05)。糖尿病肾病组MAGE、SDBG、MBG均明显高于糖尿病非肾病组,差异均有统计学意义(P <0.05)。Spearman相关分析结果显示,UACR与MAGE呈明显正相关(P <0.05)。Logistic回归分析结果显示,MAGE与SDBG是2型糖尿病患者发生糖尿病肾病的危险因素(P <0.0 5)。结论MAGE与SDBG是2型糖尿病患者发生糖尿病肾病的独立危险因素。

Objective To investigate the correlation between blood glucose fluctuation and diabetic nephropathy in patients with type 2 diabetes.Methods A total of 338 patients with type 2 diabetes who were admitted to Daxing Teaching Hospital of Capital Medical University from May 2021 to December 2021 were divided into diabetic nephropathy group(DN1 group)and diabetic non-nephropathy group(DN0 group)according to whether or not they had diabetic nephropathy,with 169 patients in each group.Fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),fasting C-peptide,triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),uric acid(UA),urinary albumin/creatinine ratio(UACR),creatinine and glomerular filtration rate(eGFR)were measured in all patients.Mean blood glucose(MBG),standard deviation of blood glucose level(SDBG)and mean amplitude of glycemic excursions(MAGE)were monitored by the continuous glucose monitoring system.Results There were no significant differences in FPG,HbA1c,fasting C-peptide,TG,LDL-C,HDL-C and UA between diabetic nephropathy group and diabetic non-nephropathy group(P>0.05).The UACR and creatinine of diabetic nephropathy group were significantly higher than those of diabetic non-nephropathy group,and the differences were statistically significant(P<0.05).The glomerular filtration rate(eGFR)of diabetic nephropathy group was significantly lower than that of diabetic non-nephropathy group,and the difference was statistically significant(P<0.05).MAGE,SDBG and MBG in diabetic nephropathy group were significantly higher than those in diabetic non-nephropathy group,and the differences were statistically significant(P<0.05).Spearman test showed that UACR was positively correlated with MAGE(P<0.05).Logistic regression showed that MAGE and SDBG were risk factors for diabetic nephropathy in type 2 diabetes mellitus(P<0.05).Conclusion MAGE and SDBG are independent risk factors for diabetic nephropathy in patients with type 2 diabetes mellitus.