2型糖尿病患者血糖变异性与冠状动脉病变程度之间的关系

摘要

Objective:To assess the relationship between glycemic variability and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM).Methods:In 521 T2DM patients with chest pain,coronary angiography revealed CAD (coronary stenosis ≥50％ luminal diameter narrowing) in 381 patients and 140 patients without CAD.Gensini score was used to assess the severity of CAD.All participants' CGMS parameters and biochemical characteristics were measured at baseline.Results:(1) Diabetic patients with CAD were older,and more were male and cigarette smokers compared with the controls.Levels of the mean amplitude of glycemic excursions (MAGE) (3.9 ± 1.2) vs.(3.3 ± 1.0)mmol/L(P ＜0.001),postprandial glucose excursion (PPGE) (4.1 ± 1.8) vs.3.4 ± 1.5 mmol/L(P ＜ 0.001),serum highsensitive C-reactive protein (hs-CRP) (10.1 ± 11.1) vs.(5.9 ± 6.0) mg/L (P ＜ 0.001) and creatinine (Cr) (87 ±21) vs.(76 ± 17) mmol/L,P ＜0.001) were significantly higher in patients with CAD than in patients without CAD.(2) Gensini score closely correlated with age,MAGE,PPGE,hemoglobin A1c (HbA1c).(3)Multiple stepwise regression analysis indicated that age (P ＜ 0.001),MAGE (P ＜ 0.001),serum levels of HbA1c (P =0.031) and hs-CRP (P =0.003) were independent determinants for Gensini score.Conclusion:The intraday glycemic variability is associated with the presence and severity of CAD in patients with T2DM.Effects of glycemic excursions on vascular complications should not be neglected in diabetes.%目的:探讨2型糖尿病患者血糖变异性与冠状动脉病变程度之间的关系.方法:连续入选因胸痛入我院准备行冠状动脉造影的2型糖尿病患者521例,入院采集一般资料后采用动态血糖监测系统(CGMS)进行连续3d的血糖监测反映血糖波动情况,然后行冠状动脉造影并根据结果分为冠心病组381例、非冠心病组140例,用Gensini积分法评价冠状动脉病变程度.对两组间各项参数进行比较,并与Gensini积分进行相关性分析.结果:①冠心病组患者日内平均血糖波动幅度(MAGE)、餐后血糖波动幅度(PPGE)、超敏C反应蛋白(hs-CRP)和血肌酐(Cr)水平明显高于对照组[MAGE(3.9±1.2)vs.(3.3±1.0) mmol/L,PPGE (4.1±1.8) vs.(3.4±1.5) mmol/L,hs-CRP(10.1±11.1) vs.(5.9±6.0) mg/L,Cr(87±21)vs.(76±17) mmol/L,均P＜0.001].②在整体研究患者中Pearson相关性分析显示Gensini积分和MAGE、年龄、PPGE、糖化血红蛋白(HbA1c)水平密切正相关.③以Gensini积分作为因变量,各相关因素作为自变量进行多因素逐步回归分析表明年龄、MAGE、hs-CRP和HbA1c是影响Gensini积分的独立危险因子.结论:在2型糖尿病患者中日内血糖波动幅度影响冠状动脉病变程度,日内血糖波动幅度越大冠状动脉病变程度越重,血糖波动性的风险应该得到广泛关注.