葡萄糖在目标范围内时间和糖尿病足的相关性研究

吴道爱; 金国玺; 时照明; 吴晨辰; 孙卫华; 陈丽

doi:10.16766/j.cnki.issn.1674-4152.003415

葡萄糖在目标范围内时间和糖尿病足的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003415

1.
蚌埠医科大学第一附属医院内分泌科，安徽蚌埠 233004
2.
蚌埠医科大学第一附属医院输血科

基金项目:

安徽省临床医学研究转化专项项目 202204295107020049

蚌埠医学院自然科学基金项目 2020byzd112

详细信息

通讯作者:
金国玺，E-mail：jyzjyz1999@163.com

中图分类号: R587.2
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- 被引次数: 0
出版历程
- 收稿日期: 2023-05-18
- 网络出版日期: 2024-05-27

Correlation between time in range and diabetic foot in patients with type 2 diabetes mellitus

1.
Department of Endocrinology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨目标范围内时间(TIR)等血糖波动指标和糖尿病足(DF)的相关性。方法选取2020年1—12月在蚌埠医科大学第一附属医院内分泌科佩戴瞬感动态血糖监测的163例2型糖尿病(T2DM)住院患者为研究对象。按有无DF分为DF组(26例)和非DF组(NDF，137例)；DF组再按Wagner分级分为Wagner 3级组(17例)和Wagner 4级组(9例)。所有患者行眼底照相和感觉阈值(VPT)测定，监测目标范围内时间(TIR)、高于目标范围时间(TAR)、低于目标范围时间(TBR)、葡萄糖变异系数(CV)和平均血糖波动幅度(MAGE)，比较上述指标的差异。结果 DF组和NDF组TIR[(35.19±10.94)% vs.(44.79±10.60)%]，CV[36.65(29.45, 38.75)% vs. 29.90(24.60, 34.80)%]、TAR[(61.46±12.21)% vs.(54.01±11.22)%]、TBR[1.00(0.00, 5.75)% vs. 0.00(0.00, 1.00)%]、眼底照相阳性比例(19/26 vs. 96/137)和VPT异常比例(25/26 vs. 45/137)比较差异均有统计学意义。Wagner 3级和4级组CRP和VPT异常比例高于NDF组，TIR低于NDF组，差异均有统计学意义(P < 0.05)。多因素logistic回归分析显示，CRP(OR=1.024, P=0.011)、眼底照相(OR=0.113，P=0.013)、VPT(OR=31.803，P=0.042)是DF的独立影响因素。结论 DF患者易合并DM视网膜病变和神经病变，感染是其独立危险因素；低TIR、高CV提示血糖控制差且波动，可能与DF发生有关。
- 糖尿病足 /
- 糖尿病 /
- 血糖波动 /
- 目标范围内时间 /
- 葡萄糖变异系数
Abstract: Objective To investigate the correlation between glycemic variability such as time in range (TIR) and diabetic foot (DF). Methods The study included 163 inpatients with T2DM who underwent prompt dynamic blood glucose monitoring at the Department of Endocrinology, the First Affiliated Hospital of Bengbu Medical University between January 2020 and December 2020. The participants were divided into two groups based on the presence or absence of DF: the DF group (n=26) and the non-DF group (NDF, n=137). The DF group were divided into two sub-groups based on the Wagner classification: Wagner grade 3 group (n=17), Wagner grade 4 group (n=9). All patients underwent fundus photography and sensory threshold (VPT) measurement, additionally, their glucose levels were monitored using TIR, time above range (TAR), time below range (TBR), glucose coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE). The above indices were compared statistically. Results TIR [(35.19±10.94) % vs. (44.79±10.60) %], CV [36.65 (29.45, 38.75) % vs. 29.90 (24.60, 34.80) %], TAR [(61.46±12.21) % vs.(54.01±11.22) %], TBR [1.00 (0.00, 5.75) % vs. 0.00 (0.00, 1.00) %], fundus photography (19/26 vs. 96/137) and abnormal proportion of VPT (25/26 vs. 45/137), there were statistical differences between the DF and NDF groups. The rates of CRP and VPT were higher in the Wagner grade 3 and 4 groups compared to the NDF group. Additionally, the TIR was lower in both groups compared to the NDF group, with statistically significant differences. The results of the multiple logistic regression analysis indicate that CRP (OR=1.024, P=0.011), fundus radiography (OR=0.113, P=0.013) and VPT (OR=31.803, P=0.042) were independent influencing factors for DF. Conclusion DF can be complicated by DM retinopathy and neuropathy, and infection is an independent risk factor. A higher CV was observed with lower TIR, indicating poor and fluctuating blood glucose levels. This may be associated with the development of DF.
- Diabetic foot /
- Diabetes mellitus /
- Glycemic variability /
- Time in range /
- Glucose coefficient of variation

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表 1 DF组和NDF组T2DM患者一般指标和血糖波动指标比较

Table 1. Comparison of general indexes and blood glucose fluctuation indexes of T2DM patients between the DF group and the NDF group

组别	例数	性别(例)		年龄(x ± s，岁)	吸烟[例(%)]	病程[M(P₂₅, P₇₅), 年]	CRP[M(P₂₅, P₇₅), mg/L]	HbA1c[M(P₂₅, P₇₅), %]	眼底照相(例)
组别	例数	男性	女性	年龄(x ± s，岁)	吸烟[例(%)]	病程[M(P₂₅, P₇₅), 年]	CRP[M(P₂₅, P₇₅), mg/L]	HbA1c[M(P₂₅, P₇₅), %]	阴性	阳性
DF组	26	15	11	62.42±11.19	3(11.54)	16.50(9.25, 20.00)	30.22(8.36, 68.99)	10.30(8.72, 12.60)	7	19
NDF组	137	85	52	57.68±13.90	21(15.33)	10.00(3.00, 15.00)	2.00(1.00, 5.00)	8.80(7.50, 10.60)	41	96
统计量		0.039^a		1.640^b	0.264^a	-3.156^c	-5.935^c	-2.620^c	15.687^a
P值		0.843		0.064	0.769	0.002	< 0.001	0.009	< 0.001

组别	例数	VPT(例)			TAR(x±s，%)	TBR[M(P₂₅, P₇₅), %]	TIR(x±s，%)	CV[M(P₂₅, P₇₅), %]	MAGE(x±s，mmol/L)
组别	例数	正常	异常	疑似	TAR(x±s，%)	TBR[M(P₂₅, P₇₅), %]	TIR(x±s，%)	CV[M(P₂₅, P₇₅), %]	MAGE(x±s，mmol/L)
DF组	26	0	25	1	61.46±12.21	1.00(0.00, 5.75)	35.19±10.94	36.65(29.45, 38.75)	7.23±2.51
NDF组	137	31	45	61	54.01±11.22	0.00(0.00, 1.00)	44.79±10.60	29.90(24.60, 34.80)	6.92±2.53
统计量		27.483^a			3.059^b	-2.980^c	4.210^b	-0.650^c	0.589^b
P值		< 0.001			0.007	0.003	< 0.001	0.003	0.557
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 3组T2DM患者一般指标和血糖波动指标比较

Table 2. Comparison of general indicators and blood glucose fluctuation indicators in 3 groups of T2DM patients

组别	例数	性别(例)		年龄(x ± s，岁)	吸烟[例(%)]	病程[M(P₂₅, P₇₅), 年]	CRP[M(P₂₅, P₇₅), mg/L]	HbA1c[M(P₂₅, P₇₅), %]	眼底照相(例)
组别	例数	男性	女性	年龄(x ± s，岁)	吸烟[例(%)]	病程[M(P₂₅, P₇₅), 年]	CRP[M(P₂₅, P₇₅), mg/L]	HbA1c[M(P₂₅, P₇₅), %]	阴性	阳性
NDF组	137	85	52	57.68±13.91	21(15.33)	10.00(3.00, 15.00)	2.00(1.00, 5.00)	8.80(7.50, 10.60)	41	96
Wagner 3级组	17	8	9	62.35±10.68	2(11.76)	16.00(9.00, 20.00)^c	35.63(13.10, 58.80)^c	9.30(8.20, 11.50)	6	11^c
Wagner 4级组	9	7	2	62.56±12.78	1(11.11)	20.00(10.00, 20.00)^c	17.00(7.77, 90.00)^c	12.30(10.50, 13.80)^c	1	8^c
统计量		2.516^a		1.337^b	0.252^a	10.493^d	35.420^d	9.504^d	18.972^a
P值		0.284		0.266	0.882	0.005	< 0.001	0.009	< 0.001

组别	例数	VPT(例)			TAR(x±s，%)	TBR[M(P₂₅, P₇₅), %]	TIR(x±s，%)	CV[M(P₂₅, P₇₅), %]	MAGE(x±s，mmol/L)
组别	例数	正常	异常	疑似	TAR(x±s，%)	TBR[M(P₂₅, P₇₅), %]	TIR(x±s，%)	CV[M(P₂₅, P₇₅), %]	MAGE(x±s，mmol/L)
NDF组	137	31	45	61	54.01±11.22	0.00(0.00, 1.00)	44.79±10.60	29.90(24.60, 34.80)	6.60(5.20, 8.40)
Wagner 3级组	17	0	16	1^c	59.88±13.11	2.00(0.00, 7.00)	35.94±11.46^c	36.30(32.00, 37.70)	6.72(5.26, 9.37)
Wagner 4级组	9	0	9	0^c	64.44±10.32^c	1.00(0.00, 3.00)^c	33.78±10.37^c	37.00(27.00, 39.10)^c	7.60(5.88, 9.01)
统计量		35.919^a			5.151^b	9.337^d	8.940^b	8.871^d	0.605^d
P值		< 0.001			0.007	0.009	< 0.001	0.012	0.739
注：^a为χ²值，^b为F值，^d为H值。与NDF组比较，^cP < 0.05。

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表 3 变量赋值情况

Table 3. Variable assignment

变量	赋值方法
性别	男性=1，女性=2
吸烟	否=1，是=2
眼底照相	阴性=0，阳性=1
VPT	正常=0，疑似=1，异常=2
有无DF	无=0，有=1
连续型变量	以实际值赋值

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表 4 DF的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of the DF group

变量	B	SE	Waldχ²	P值	OR值	95% CI
CRP	0.024	0.009	6.513	0.011	1.024	1.008~1.047
眼底照相	-2.178	0.879	6.137	0.013	0.113	0.028~0.544
VPT	3.460	1.700	4.144	0.042	31.803	2.925~631.306

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