老年2型糖尿病患者血糖波动与颈动脉内膜中层厚度的关系

Correlation between Blood Glucose Excursion and Carotid Intima-media Thickness in the Elderly with Type 2 Diabetes Mellitus

中文关键词: 老年  2型糖尿病  血糖波动  颈动脉内膜中层厚度

英文关键词: elderly  type 2 diabetes mellitus  blood glucose excursions  carotid intima-media thickness (CIMT)

中文摘要:

      目的 探讨老年2型糖尿病患者血糖波动与颈动脉内膜中层厚度之间的关系.方法 选取2014年1月-2015年12月住院的59例老年2型糖尿病患者作为研究对象,所有患者均用动态血糖监测系统进行72 h血糖监测,采用高分辨彩色多谱勒超声诊断仪测定颈动脉内膜中层厚度(CIMT),并柃测糖化血红蛋白、C肽、三酰甘油、总胆固醇、高密度脂蛋白和低密度脂蛋白等.根据动态血糖监测结果,按平均血糖波动幅度的中位数分为血糖波动大组(A组)和血糖波动小组(B组).结果 2组患者在性别、年龄、C反应蛋白、总胆固醇、低密度脂蛋白、三酰甘感油、谷丙转氨酶、血肌酐、空腹血糖、餐后2h血糖及平均血糖这些临床资料上均无统计学差异(P＞0.05).A组的糖化血红蛋白较B组的明显升高(8.74±2.41) ％vs (7.39±1.58)％,P=0.015,而胰岛功能明显降低[空腹C肽:0.7 (0.3 ～ 1.4) ng/mL vs1.6 (0.78～2.13) ng/mL,P=0.004;餐后2hC肽:1.8 (1.1～2.9) vs3.45 (1.35～5.13) ng/mL,P=0.018LA组的日间血糖绝对差及平均血糖波动幅度较B组更大(2.11±1.12) mmol/Lvs (1.23±0.56) mmol/L,P=0.001;(5.90± 1.48) ng/mLvs(2.54±0.92)mmol/L,P＜0.001.A组的平均CIMT为(0.99±0.36) mm,较B组CIMT (0.81±0.25) mm增厚,2组间差异具有统计学意义(P=0.040).回归分析显示,平均血糖波动幅度为CIMT升高的独立危险因素,而2hC肽为CIMT升高的保护因素.结论 在老年2型糖尿病患者中,血糖波动与颈动脉内膜中层厚度有关,可能是老年糖尿病患者心脑血管疾病的危险因素.

英文摘要:

      Objective To explore the correlation between blood glucose excursion and carotid intima-media thickness (CIMT) in the elderly with type 2 diabetes mellitus.Methods 59 elderly hospitalized during the period from Jan.,2014 to Dec.,2015 were selected;continuous glucose monitoring system (CGMS) was applied in monitoring 72 h blood glucose of all the cases and Doppler ultrasound examination in measuring CIMT;the levels of glycosylated hemoglobin (HbAlc),C-peptide,triglyceride,total cholesterol,high-density lipoprotein and low density lipoprotein were detected;the 59 cases were divided,based on the median of mean amplitude of blood glucose excursion,into 2 groups:group A (with greater excursions) and group B (with smaller excursions).Results There existed no statistical difference in the clinical data (including sex,age,C-reactive protein,total cholesterol,low density cholesterol,triglyceride,alanine transaminase,serum creatinine,fasting blood glucose,2 hours postprandial blood glucose (P2hBG) and average blood glucose) between the 2 group (P＞ 0.05);the level of A1 (HbA1c) of the cases in group A increased much more than that of the cases in group B [(8.74±2.41) ％ vs (7.39± 1.58) ％,P=0.015] while beta-cell function was lower in Group A than in Group B [fasting C-peptide;0.7 (0.3-1.4)vs 1.6 (0.78-2.13) ng/mL,P=0.004;2 h C-peptide:1.8 (1.1-2.9) vs 3.45 (1.35-5.13) ng/mL,P--0.018];the absolute difference of day-to-day blood glucose excursions and mean amplitude of glucose excursions were greater in Group A than those in Group B [(2.11±1.12) vs (1.23±0.56) mmol/L,P=0.001;(5.90±1.48) vs (2.54±0.92) mmol/L,P＜0.001];regression analysis indicated that mean amplitude of glucose excursions was the independent risk factor of increased CIMT while 2 h C-peptide was the protective factor of increased CIMT.Conclusions Blood glucose excursion is correlated to CIMT in the elderly with type 2 diabetes mellitus,which may be the risk factor of cardio-cerebrovascular diseases in the elderly with diabetes mellitus.