2型糖尿病患者糖化血红蛋白及血糖波动相关性临床研究

摘要

目的：探讨2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)及血糖波动相关性。方法：272例的T2DM患者，男141例、女131例，年龄(67.3±4.9)岁，糖尿病(DM)病程2个月～30年，体重指数在14.5～35kg/m2,符合1999年WHO T2DM诊断分型标准。按HbA1c水平分为三组：Ⅰ组(HbA1c≤7.0％)117例、Ⅱ组(7.0％～≤10％)129例、Ⅲ组(＞10％)26例，分析其血糖谱参数,包括观察日内平均血糖水平(MBG)、空腹平均血糖(MFBG)、三餐后平均血糖水平、日内最大血糖漂移幅度(LAGE)、日内平均血糖波动幅度(MAGE)及波动次数(NGE)、不同血糖水平所占日内时间百分比(PT)，HbA1c及血糖的波动各指标相关性。结果：三组的HbA1c水平与MBG、血糖波动系数、NGE、MAGE差异无统计学意义。三组的高PT随着HbA1c的增高是逐渐升高，组间差异无统计学意义(P>0.05)。低PT：Ⅰ组与Ⅱ组比较没有统计学意义(P>0.05)，Ⅰ组和Ⅱ组与Ⅲ组比较均有统计学意义(P＜0.01)；MFBG：Ⅰ组与Ⅱ组对比差异有统计学意义(P＜0.01)，Ⅰ组和Ⅱ组与Ⅲ组比较比较差异无统计学意义(P>0.05)。三组餐后2h平均血糖水平都在较高水平，差异无统计学意义(P>0.05)。结论：HbA1c不能反映血糖水平波动的幅度和频率；HbA1c与血糖波动幅度的关系可能根据HbA1c所在范围不同存在不同差异；HbA1c水平下降发生低血糖概率会增高；良好血糖控制的DM患者依然存在明显的餐后高血糖现象。%Objective:To investigate type 2 diabetes mellitus(T2DM) patients with glycated hemoglobin (HbA1c) and blood glucose lfuctuation correlation. Methods: 272 cases of type 2 diabetes, and 141 cases of male and female 131 cases, age (67.3±4.9) years of age, duration of diabetes 2 months to 30 years, BMI 14.5 ~ 35kg/m2, in line with 1999 WHO T2DM diagnosis of type standards. HbA1c levels were divided into three groups according to: Ⅰ group (HbA1c≤7.0%) 117 cases, Ⅱ group (7.0%~≤10%) 129 cases, Ⅲ group(>10%), 26 cases analyzed their blood glucose spectral parameters, including observation days of average blood glucose levels(MBG), mean fasting blood glucose (MFBG), average blood glucose levels after meals, days maximum amplitude of glycemic excursion (LAGE), days of average blood glucose lfuctuations (MAGE) and lfuctuations in the number of (NGE), blood glucose levels are different representing the percentage of days time(PT), HbA1c and blood sugar lfuctuations in each index correlation. Results: Three groups of HbA1c levels and MBG, blood glucose lfuctuation coefifcient, NGE, MAGE difference was not statistically signiifcant. High PT increased as HbA1c is gradually increased, there was no signiifcant difference between groups(P>0.05). Low PT: Ⅰ group and Ⅱ group was not statistically signiifcant(P>0.05), Ⅰand groupⅡandⅢgroup were statistically signiifcant(P<0.01);MFBG:Ⅰgroup comparison groupⅡwas signiifcantly(P<0.01),Ⅰand groupⅡandⅢgroup difference was not statistically signiifcant(P>0.05). Three groups of postprandial 2h average blood glucose levels are at a high level, the difference was not statistically signiifcant(P>0.05). Conclusions:HbA1c does not relfect the magnitude and frequency of lfuctuations in blood glucose levels;relationship between HbA1c and blood glucose lfuctuations may vary according to the scope HbA1c differences exist different location;HbA1c levels decline will increase the probability of hypoglycemia;good glycemic control in diabetic patients remains a signiifcant postprandial hyperglycemia.