摘要:
目的 探讨动态血糖监测(CGF)和静脉血浆葡萄糖、毛细血管全血葡萄糖的关系.以血糖的"稳态"为基础,侧重于分析非"稳态"状态下,静脉血浆葡萄糖测定和CGF数据的差异和相关性.方法 取自2015年1~8月云南省第一人民医院内分泌代谢科住院和门诊患者32例,其中2型糖尿病29例,低血糖查因3例.采用葡糖氧化酶(GOD)、CGF和动态血糖监测系统(DGMS)3种方法测定血糖,比较各组数据间的差异和相关性.结果 DGMS(122)数值略低于CGF(122)测定值,两者虽然仅相差(0.11±0.35)mmol/L,但差异具有统计学意义(p=0.001).口服葡萄糖耐量试验(OGTT)过程中,0 min GOD低于DGMS(p=0.000),30 min起GOD迅速超过DGMS(p=0.001),从120 min开始DGMS上升的速度快于GOD,虽然仍较GOD为低,但两者间差异已没有统计学意义(p>0.05).合并5组数据后,GOD(160)与DGMS(160),均数比较,差异仍有统计学意义(p=0.000),提示血浆葡萄糖的浓度整体水平高于组织液.CGF(122)与DGMS(122)相关系数为0.989(p=0.000),GOD(160)与DGMS(160)相关系数为0.911(p=0.000).结论 在稳态状态下,CGF全血葡萄糖与DGMS之间有非常好的相关关系,并以稳态状态为基础,比较OGTT或馒头餐耐量试验过程中,随着血糖快速升高,DGMS监测的葡萄糖浓度也随之升高,变化趋势与GOD相类似,但是绝对值显示DGMS的反应较GOD慢,进餐后到120 min以前DGMS测定值偏低,但120 min起DGMS与GOD血糖浓度差异已经没有统计学意义,这是在非稳态状态下做出的结果,反应了真实的血糖情况,而且综合5个点的分析,最终的结果是DGMS和GOD有很好的相关性.%Objective To investigate the relationships among dynamic glucose monitoring system (DGMS), glucose oxidase (GOD) and capillary glucose fingertip (CGF) and especially to analyze the difference and relation between DGMS and CGF under non-stable condition on the basis of stable condition of blood glucose. Methods GOD, CGF and DGMS were used to test blood glucose of 32 inpatients and outpatients from January to August 2015 and the difference and relation of these data were compared. There were 29 cases of type 2 diabetics and 3 cases of hypoglycemia in these patients. Results The value of DGMS (122) was lower than that of CGF (122); though the difference was only (0.11 ± 0.35) mmol/L, it was of significance ( p= 0.001). During oral glucose tolerance test (OGTT), the value of GOD was lower than that of DGMS at 0 min ( p= 0.000); from 30 min on the GOD value quickly exceeded DGMS value ( p= 0.001); and starting at 120 minutes the DGMS value rose faster than GOD, though it was still lower than the GOD value, they did not have marked difference (p >0.05). After merging 5 sets of data, the mean of GOD (160) had marked difference from that of DGMS (160) ( p= 0.000), which indicated that the glucose concentration of plasma was higher than that of tissue fluid. The correlation coefficient between CGF (122) and DGMS (122) was 0.989 ( p= 0.000) and that between GOD (160) and DGMS (160) was 0.911 ( p= 0.000). Conclusions Under stable state, there is a great relation between CGF and DGMS. On the basis of stable state, during OGTT or steamed bread meal tolerance test, with rapid increase of blood glucose, the glucose concentration of DGMS also rises in a trend similar to that of GOD. However, the reaction of DGMS is slower than that of GOD from the analysis of absolute value, and the blood glucose concentrations of the two methods do not have marked difference from 120 min on. This is the result of an unsteady state that reflects the true blood glucose. And the final comprehensive analysis of the five-points reveals that DGMS and GOD is in good correlation.