葡萄糖目标范围内时间与2型糖尿病创面愈合的相关性研究

Relationship between time in range and wound healing in type 2 diabetes mellitus

目的观察并分析葡萄糖目标范围内时间(TIR)与2型糖尿病(T2DM)创面愈合的相关性。方法选取T2DM合并创面患者315例,根据是否存在创面难愈,将其分为创面难愈组(90例)和非创面难愈组(225例)。使用倾向性评分匹配法(PSM)将匹配成功的40对患者分为非创面难愈PSM组(40例)和创面难愈PSM组(40例)。收集所有患者一般临床资料及实验室检查结果并分组进行比较。采用logistic回归分析评价TIR和糖尿病创面难愈的关系;采用Spearman相关分析评估双变量间的相关性。结果PSM前,创面难愈组年龄、糖尿病病程、糖化血红蛋白(HbA1c)、血肌酐(SCr)、中性粒细胞计数、创面面积、血糖平均值及标准差、葡萄糖高于目标范围内时间(TAR)、踝关节以下创面、动脉粥样硬化(AS)及抗PLT药物史患者比例均高于非创面难愈组,葡萄糖目标范围内时间(TIR)及白蛋白水平均低于非创面难愈组;PSM后,创面难愈组患者血糖标准差、TAR均高于非创面难愈组,TIR低于非创面难愈组(P<0.05)。PSM前,两组不同TIR水平(血糖控制差、血糖控制未达标及血糖控制达标)患者比例比较差异有统计学意义(P<0.001),随着TIR水平升高,创面难愈的发病率逐渐降低。Spearman相关分析结果显示,TIR水平与创面难愈发病风险呈负相关(P<0.001),logistic回归校正混杂因素后结果显示,TIR每增加10%,创面难愈发病风险降低39.5%(P<0.001)。PSM后两组不同TIR水平患者比例比较差异有统计学意义(P=0.006),随着TIR水平升高,创面难愈的发病率逐渐下降。Spearman相关分析结果显示,TIR水平与创面难愈发病风险呈负相关(P<0.05),logistic回归校正混杂因素后结果显示,TIR每增加10%,创面难愈风险降低18.6%(P<0.05)。结论TIR水平与T2DM创面难愈发病风险呈负相关,TIR可能是评估T2DM创面难愈发生风险的重要指标之一。

Objective To observe and analyze the relationship between time in range(TIR)and wound healing in type 2 diabetes mellitus(T2DM).Methods A total of 315 patients with T2DM complicated with wounds were selected.According to the presence or absence of refractory wound healing,all patients were divided into refractory wound healing group(90 cases)and non-refractory wound healing group(225 cases).The 40 pairs of patients who were successfully matched were divided into non-wound refractory PSM group(40 cases)and wound refractory PSM group(40 cases)using propensity score matching(PSM).The general clinical data and laboratory examination results of all patients were collected and compared between groups.Logistic regression analysis was used to evaluate the relationship between TIR and diabetic wound refractory healing.Spearman correlation analysis was used to assess the correlation between the two variables.Results Before PSM,the age,diabetes mellitus disease duration,glycosylated hemoglobin A1c(HbA1c),serum creatinine(SCr),neutrophil count,wound area,mean blood glucose,standard deviation,time above range(TAR),proportion of wounds below the ankle joint,proportion of atherosclerosis(AS),and proportion of patients with a history of antiplatelet drugs in wound refractory group were higher than those in non-wound refractory group,while time in range(TIR)and albumin levels were lower than those in non-wound refractory group.After PSM,the standard deviation of blood glucose and TAR of patients in wound refractory group were higher than those in non-wound refractory group,and TIR was lower than that in non-wound refractory group(P<0.05).Before PSM,there were statistically significant differences in the constituent ratios of patients with different TIR levels(poor blood glucose control,unsatisfactory blood glucose control and qualified blood glucose control)between the two groups(P<0.001).With the increase of TIR level,the incidence of refractory wound healing inereased gradually.Spearman correlation analysis showed that TIR level was negatively correlated with the risk of refractory wound healing(P<0.001).After adjusting for confounding factors by logistic regression,for every 10%increase in TIR,the risk of refractory wound healing decreased by 39.5%(P<0.001).There was significant difference in the proportion of patients with different TIR levels between the two groups after PSM(P=0.006).The incidence of refractory wound healing of patients healing group decreased gradually.Spearman correlation analysis showed that TIR level was negatively correlated with the risk of refractory wound healing(P<0.05).After adjusting the confounding factors by logistic regression,for every 10%increase in TIR,the risk of refractory wound healing decreased by 18.6%(P<0.05).Conclusion TIR level is negatively correlated with the risk of refractory wound healing in patients with T2DM.TIR may be one of the important indicators to evaluate the risk of refractory wound healing in patients with T2DM.