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糖化血红蛋白达标的2型糖尿病患者微量白蛋白尿与血糖波动的相关性分析

王奕,孟祥英,高清歌,陆燕蓉,周勇   

  1. 上海市徐汇区大华医院
  • 收稿日期:2012-03-12 修回日期:2012-08-08 出版日期:2012-12-15 发布日期:2012-12-15
  • 通讯作者: 王奕

The relationship of blood glucose variability and microalbuminurla in type 2 diabetic patients in well-controlled glycosylated hemoglobin

  • Received:2012-03-12 Revised:2012-08-08 Published:2012-12-15 Online:2012-12-15
  • Contact: yi WANG

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摘要： 目的 分析糖化血红蛋白(HbAlc)控制达标的2型糖尿病患者微量白蛋白尿(MAU)与血糖波动的相关性。方法 对131例HbAlc <7.0％的2型糖尿病患者分为高、正常尿白蛋白排泄率（UAER）组，进行动态血糖监测(CGM)，对两组CGM中连续72 h的平均血糖水平(MBG)，血糖波动系数（BGFC），低血糖时间比(<3.9mmol/L)，高血糖时间比(>7.8mmol/L)，高血糖时间比(>11.1mmol/L)作比较，分析微量白蛋白尿与上述指标相关性。结果 (1) 高UAER组糖尿病病程、血尿酸、空腹C肽、BGFC及高血糖时间比1（>7.8 mmol/L）与正常UAER组相比差异有统计学意义（P1.5组，63例（48%），及BGFC<1.5%组，68例（52%）。BGFC >1.5组其UAER升高的发生率高于BGFC<1.5组 (80.8%比42.6%，P<0．05)。同时两组糖尿病病程、UAER、糖化血清蛋白（GA）、MBG、高血糖时间比(>7.8mmol/L)，高血糖时间比(>11.1mmol/L)差异有统计学意义（P值分别为0.016、0.022、0.001、<0.001、<0.001、<0.001）。(3) 以UAER作为因变量，进行Spearman相关性分析显示，UAER与糖尿病病程、血尿酸、血糖波动系数呈正相关（r=0.249，p=0.004；r=0.212，p=0.015 ； r=0.191，p=0.029），与空腹C肽呈负相关（r=-0.199，p=0.023 ）。Logistic回归分析显示空腹C肽、血尿酸、血糖波动系数与患者UAER升高独立相关(OR=1.349，p= 0.036；OR=1.005 p= 0.032；OR=1.582 p= 0.027) 。结论 糖尿病病程、高血糖时间比、糖化血清蛋白是影响血糖波动水平的主要因素。血糖波动是HbAIc控制理想的2型糖尿病患者UAER升高的危险因素之一。

关键词: 2型糖尿病, 尿白蛋白排泄率, 血糖波动

Abstract: Objective To investigate the relationship of the blood glum variability and microalbuminuria(MAU)in type 2 diabetic patients with well-controlled glycosylated hemoglobin(HbAlc)。 Methods One hundred and thirsty-one type 2 diabetic patients with HbAlc under 7.0％ were divided high UAER group and normal UAER group。 Using the continuous glucose monitoring system (CGMS)，blood glucose fluctuate coefficient（BGFC），mean blood glucose（MBG）, percentage of time(PT) below 3.9mmol/L and above 7.8 and 11.1mmol/L were received。Then the data were analysis by the statistical analysis。Results (1)The course of disease ，uric acid （UA），fasting C-peptide, BGFC and PT(>7.8mmol/L) were significantly higher than those of the normal UAER group (p<0.05或p<0.01). (2)The course of disease ，urine albumin exclusion rate （UAER），serum glycosylated albumin（GA），MBG ，PT(>7.8mmol/L) and PT(>11.1mmol/L) in BGFC >1.5 group were higher than those of the BGFC<1.5 group (p= 0.016、0.022、0.001、<0.001、<0.001、<0.001）.（3）、Spearman regression analyses indicated that course of disease and UA and fasting C-peptide and BGFC were the independent influential factors of UAER（r=0.249，p=0.004；r=0.212，p=0.015 ；r=-0.199，p=0.023 ；r=0.191，p=0.029）. Logistic regression analyses indicated that UA and fasting C-peptide and BGFC were the risk factors of UAER (OR=1.349，p= 0.036；OR=1.005 p= 0.032；OR=1.582 p= 0.027) 。Conclusion In well-controlled patients with type 2 diabetes，course of disease and PT(>7.8mmol/L、>11.1mmol/L) and GA were the main factors influencing glucose variability。 The blood glucose variability is one of the risk factors for UAER。

Key words: Diabetes mellitus, type 2, Urine albumin exclusion rate, Blood glucose variability