波动性高血糖和持续性高血糖对2型糖尿病患者血管并发症的影响

朱晨希; 李丽燕; 赵旭东; 郝敬波; 李雷

doi:10.16766/j.cnki.issn.1674-4152.003659

波动性高血糖和持续性高血糖对2型糖尿病患者血管并发症的影响

doi: 10.16766/j.cnki.issn.1674-4152.003659

1.
徐州医科大学附属医院全科医学科，江苏徐州 221002
2.
徐州医科大学附属医院老年医学科

基金项目:

江苏省老年健康科研项目 LK2021015

详细信息

通讯作者:
李雷，E-mail：ligroup-999@126.com

中图分类号: R587.1
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出版历程
- 收稿日期: 2024-01-11

Impact of fluctuating and persistent hyperglycemia on vascular complications in patients with type 2 diabetes mellitus

1.
Department of General Practice, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China

摘要

摘要: 目的观察波动性高血糖和持续性高血糖对2型糖尿病(T2DM)患者血管并发症的影响，探讨其可能的机制。方法选择2022年11月—2023年5月在徐州医科大学附属医院新诊断的112例T2DM患者，根据平均血糖波动幅度(MAGE)分为持续性高血糖组(52例)与波动性高血糖组(60例)，评估大血管、微血管并发症。结果波动性高血糖组较持续性高血糖组2 h血糖、2 h胰岛素、颈动脉内膜中层厚度(IMT)明显升高(P < 0.05)，高敏C反应蛋白(hs-CRP)、尿白蛋白/尿肌酐(UACR)、肱动脉内皮依赖性舒张功能(EDD)、踝肱指数(ABI)明显降低(P < 0.05)；冠心病[30.0%(18例) vs. 13.5%(7例)，χ²=4.394，P=0.036]和脑梗死发生率[26.7%(16例) vs. 11.5%(6例)，χ²=4.039，P=0.044]增高，糖尿病肾病[10.0%(6例) vs. 25.0%(13例)，χ²=4.450，P=0.035]及糖尿病视网膜病变发生率[8.3%(5例) vs. 23.1%(12例)，χ²=4.703，P=0.030]降低。多因素logistic回归分析显示：大血管并发症影响因素为2 h血糖、2 h胰岛素、MAGE>3.9 mmol/L、肱动脉EDD(P < 0.05)；微血管并发症影响因素为空腹血糖、糖化血红蛋白、MAGE≤3.9 mmol/L、hs-CRP(P < 0.05)。结论波动性高血糖对T2DM患者大血管并发症影响更明显，可能与内皮功能受损有关，而持续性高血糖对T2DM患者微血管并发症影响更显著，可能与炎性反应有关。
- 2型糖尿病 /
- 波动性高血糖 /
- 内皮功能 /
- 动脉粥样硬化 /
- 炎性反应
Abstract: Objective To observe the effects of fluctuating hyperglycemia and persistent hyperglycemia on macrovascular and microvascular complications in patients with type 2 diabetes and explore the possible mechanisms. Methods A total of 112 patients with newly diagnosed type 2 diabetes mellitus who were hospitalized in the Affiliated Hospital of Xuzhou Medical University from November 2022 to May 2023 were selected and divided into two groups, 52 patients in the persistent hyperglycemia group and 60 patients in the fluctuating hyperglycemia group according to the mean amplitude of glycemic excursions (MAGE). Macrovascular and microvascular complications were assessed. Results The fluctuating hyperglycemia group had higher 2 h blood glucose, 2 h insulin, carotid intima-media thickness (IMT) than the sustained hyperglycemia group (P < 0.05), while high-sensitivity C-reactive protein (hs-CRP), urinary albumin urine creatinine (UACR), brachial endothelium-dependent diastolic function (EDD), and ankle brachial index (ABI) were significantly lower (P < 0.05). Rates of coronary heart disease [30.0% (18 cases) vs. 13.5% (7 cases), χ²=4.394, P=0.036] and rates of cerebral infarction [26.7% (16 cases) vs. 11.5% (6 cases), χ²=4.039, P=0.044] increased, peripheral arteriosclerosis worsened, and diabetic nephropathy [10.0% (6 cases) vs. 25.0% (13 cases), χ²=4.450, P=0.035] and diabetic retinopathy [8.3% (5 cases) vs. 23.1% (12 cases), χ²=4.703, P=0.030] decreased. Multivariate logistic regression analysis showed that the influencing factors of macrovascular complications were 2 h blood glucose, 2 h insulin, MAGE>3.9 mmol/L, and brachial EDD (P < 0.05). The contributing factors for microvascular complications were fasting glucose, glycated hemoglobin, MAGE≤3.9 mmol/L, and hs-CRP (P < 0.05). Conclusion Fluctuating hyperglycemia has a greater influence on macrovascular complications in patients with type 2 diabetes, possibly due to impaired endothelial function, whereas sustained hyperglycemia has a stronger impact on microvascular complications, which could be linked to inflammatory responses.
- Type 2 diabetes mellitus /
- Fluctuating hyperglycemia /
- Endothelial function /
- Atherosclerosis /
- Inflam-matory response
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表 1 2组T2DM患者临床资料比较(x±s)

Table 1. Comparison of clinical data between the two groups of T2DM patients(x±s)

组别	例数	BMI	收缩压(mmHg)	舒张压(mmHg)	总胆固醇(mmol/L)	甘油三酯(mmol/L)	低密度脂蛋白(mmol/L)	高密度脂蛋白(mmol/L)	空腹血糖(mmol/L)	2 h血糖(mmol/L)
持续性高血糖组	52	25.53±2.19	141.52±14.93	86.60±10.45	5.75±0.57	1.71±0.44	3.20±0.52	1.03±0.18	8.37±1.27	12.88±1.62
波动性高血糖组	60	24.98±2.18	140.28±15.20	85.28±10.62	5.61±0.65	1.69±0.48	3.17±0.49	1.02±0.12	8.32±1.34	13.65±1.69
t值		1.318	0.433	0.657	1.224	0.184	0.343	0.142	0.229	2.447
P值		0.190	0.666	0.512	0.223	0.855	0.733	0.888	0.819	0.016

组别	例数	糖化血红蛋白(%)	空腹胰岛素(U/L)	2 h胰岛素(U/L)	同型半胱氨酸(μmol/L)	hs-CRP (mg/L)	EDD (%)	IMT (mm)	ABI	UACR (mg/g)
持续性高血糖组	52	7.11±0.44	11.35±3.00	28.75±5.11	10.96±3.96	6.21±2.16	6.30±0.49	0.92±0.06	1.14±0.12	33.68±3.97
波动性高血糖组	60	7.15±0.40	12.13±3.31	32.63±6.27	10.43±3.99	5.39±1.40	5.98±0.60	0.95±0.06	0.92±0.13	23.99±2.88
t值		0.470	1.312	3.559	0.708	2.341	3.080	2.751	2.410	4.889
P值		0.639	0.192	0.001	0.480	0.021	0.003	0.007	0.027	0.026
注：1 mmHg=0.133 kPa。

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表 2 2组T2DM患者并发症发生率比较[例(%)]

Table 2. Comparison of complication rates between the two groups of T2DM patients[cases(%)]

组别	例数	冠心病	脑梗死	糖尿病肾病	糖尿病视网膜病变
持续性高血糖组	52	7(13.5)	6(11.5)	13(25.0)	12(23.1)
波动性高血糖组	60	18(30.0)	16(26.7)	6(10.0)	5(8.3)
χ²值		4.394	4.039	4.450	4.703
P值		0.036	0.044	0.035	0.030

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表 3 大血管并发症影响因素logistic回归分析

Table 3. Logistic regression analysis of factors influencing macrovascular complications

变量	B	SE	Waldχ²	P值	OR值	95% CI
2 h血糖	1.266	0.430	5.273	0.027	3.547	1.765~3.607
2 h胰岛素	0.047	0.524	4.163	0.035	1.048	1.036~1.361
MAGE>3.9 mmol/L	0.699	0.701	3.317	0.041	2.013	1.405~2.109
EDD	-0.302	0.072	9.622	0.012	0.739	0.519~0.867

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表 4 微血管并发症影响因素logistic回归分析

Table 4. Logistic regression analysis of factors influencing microvascular complications

变量	B	SE	Waldχ²	P值	OR值	95% CI
空腹血糖	1.081	0.330	2.853	0.029	2.947	1.465~3.172
糖化血红蛋白	0.879	0.185	4.251	0.037	2.408	1.696~3.318
MAGE≤3.9 mmol/L	0.698	0.619	3.452	0.045	2.009	1.405~2.109
hs-CRP	0.234	0.159	8.914	0.015	1.264	1.128~1.765

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