2型糖尿病患者慢性血糖波动指标与冠状动脉狭窄程度的相关性分析

摘要

Objective To investigate the correlation between the chronic glycemic excursion index and degree of coro-nary artery stenosis in patients with type 2 diabetes mellitus (T2DM),so as to provide evidence for the prevention and treatment of coronary heart disease in T2DM patients. Methods We selected 153 cases of T2DM patients undergoing cor-onary angiography due to chest pain;according to the results of coronary angiography,they were divided into the observa-tion group (T2DM combined with coronary stenosis,92 cases)and the control group (no coronary stenosis,61 cases). The fasting venous blood 4 mL from both of the two groups was extracted to measure the fasting plasma glucose (FBG)and glycosylated hemoglobin (HbA1c )levels. A continuous glucose monitoring system (CGMS)was used to monitor blood glu-cose continuously for 72 h,and we recorded the mean amplitude of glycemic excursions (MAGE),mean of daily differ-ences (MODD)and postprandial glycemic excursions (PPGE). The patients in the two groups underwent coronary angiog-raphy. Gensini integral method was used to evaluate the degree of coronary artery stenosis. Spearman method was used to analyze the correlation between Gensini score and clinical data of patients in the observation group,and the influencing fac-tors of Gensini score in the observation group were analyzed by Logistic regression analysis. Results The levels of HbA1c , MAGE,and PPGE in the observation group were higher than those in the control group (all P<0. 05). The Gensini score of the observation group was higher than that of the control group (P<0. 01). The Gensini score of the observation group was positively correlated with age,hs-CRP,HbA1c,MAGE,and PPGE (all P <0. 05). Logistic regression analysis showed that age,hs-CRP,HbA1c and MAGE were the influencing factors of Gensini score in the observation group (P<0. 05),and MAGE was an independent risk factor (OR = 3. 129,95% CI was 1. 007-7. 216). Conclusion The T2DM patients with coronary artery stenosis have higher blood glucose fluctuations,and MAGE is an independent risk factor for coronary artery stenosis in patients with T2DM.%目的 探讨2型糖尿病(T2DM)患者慢性血糖波动指标与冠状动脉狭窄程度的关系,为T2DM患者冠心病的防治提供依据.方法 选择因胸痛行冠状动脉造影的T2DM患者153例,根据冠状动脉造影结果分为观察组(合并冠状动脉狭窄)92例及对照组(不合并冠状动脉狭窄)61例.抽取两组空腹静脉血4 mL,检测空腹血糖(FBG)、糖化血红蛋白(HbA1c)水平.应用动态血糖监测系统(CGMS)实施连续72 h的血糖跟踪监测,记录血糖波动指标包括日内平均血糖波动幅度(MAGE)、日间血糖的平均绝对差(MODD)、餐后血糖的波动幅度(PPGE).对两组患者均行冠状动脉造影检查,采用Gensini积分法评价冠状动脉狭窄程度.采用Spearman法分析Gensini积分与观察组患者临床资料的相关性,采用Logistic回归法分析观察组患者Gensini积分的影响因素.结果 观察组HbA1c、MAGE、PPGE水平均高于对照组(P均<0.05).观察组Gensini积分高于对照组(P<0.01).观察组Gensi-ni积分与年龄、HbA1c、MAGE及PPGE均呈正相关(P均<0.05).Logistic回归分析示,年龄、HbA1c及MAGE是观察组Gensini积分的影响因素(P均<0.05),且MAGE为独立危险因素(OR=3.129,95%CI为1.007~7.216).结论 发生冠状动脉狭窄的T2DM患者血糖波动幅度更高,MAGE是T2DM患者发生冠状动脉狭窄的独立危险因素.