• 论著 •    

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

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