摘要
目的探讨住院糖尿病患者血糖波动与β细胞功能的关系。方法选取2007年6月至2008年7月我院内分泌科住院糖尿病患者60例，采用动态血糖监测系统（CGMS）进行血糖监测，并同时行精氨酸刺激试验，分析空腹血糖（FPG）、糖化血红蛋白（HbA1c）、24h平均血糖（MBG）、平均血糖波动幅度（MAGE）、精氨酸刺激试验C肽增值（ACP）的关系。结果（1）以HbA1c水平分为5组，绘制24hCGMS血糖谱，在HbA1c最低的两组（HbAIC〈6．5％，6．5％≤HbA1c〈7％），空腹血糖差别不大，但餐后血糖后者有所上升。随着HbA1c进-步增加，24h血糖整体水平依次增高。（2）校正了性别、年龄、病程影响后，HbA1c、MBG与FPG；MBG、MAGE与HbA1c；MBG与MAGE（r分别为0．67、0．66、0．63、0．44、0．39，P均〈0．01），FPG与MAGE（r=0．31，P〈0．05）呈正相关关系。（3）校正了性别、年龄、病程影响后，FPG、HbA1c、MAGE与ACP呈负相关关系（r=-0．30，P〈0．05；r=-0．39、-0．42，P均〈0．01）；MBG与ACP无相关（P〉0．05）。（4）以HbA1c〈7％时，ACP变化不大（2．4±0．3）啡g／L，而HbAlC≥7％时，ACP明显下降（1．4±0．9）μg／L。（5）以ACP为应变量，多元线性逐步回归分析结果显示。MAGE、血胆固醇水平、HbA1c是ACP独立影响因子（校正的R2=0．305，P〈0．01）。结论血糖波动性对胰岛β细胞功能损伤较持续性的高血糖更严重。
Objective To study the relationship between the glucose fluctuation and β cell function in the diabetes mellitus （DM） patients. Methods Sixty hospitalized DM patients, 27 males and 33 females, aged （59 -14） , with a course of DM（8 ±8） years, underwent dynamic blood glucose monitoring by continuous glucose monitoring system （CGMS）. Arginine stimulation test was conducted to detect the blood glucose and C peptide. Blood lipids were measured by automatic chemistry analyzer . The relations among fast plasma glucose （FPG）, glycated hemoglobin （ HbA1 c ）, mean glucose concentration （MBG）, mean amplitude of glycemie excursion （MAGE） , and incremental value of C peptide （ACP） were studied. Results （1）The subjects were divided into five subgroups by HbAlc, 24 h CGMS profiles showed that a progressive deterioration of the glycemic profiles from group lto 5 associated with increasing levels of HbAle. The FPG levels were not significantly different between the group of HbA1 c 〈 6.5% , and the group of 6.5% ≤HbAlc 〈 7%, but the postprandial blood glucose of the latter group was higher than that of the former group. The CGMS curve shifted upward along with the increase of HbAlc level. （2） After adjustment for sex, age, and diabetes duration, positive correlation was found between HbAlcw and FPG, MBGw and FPG, MBG and HbA1 c , MAGE and HbA1 c, and MBG and MAGE （r = 0. 67 ,0. 66 ,0. 63 ,0. 44 ,0. 39 , all P 〈 0.01 ）, and FPG and MAGE （ r = 0.31 , P 〈 0. 05 ）. （ 3 ） After adjustment for sex, age, and diabetes duration ,the ACP was negatively correlated with FPG, HbA1c and MAGE （r = -0.30, P 〈 0.05;r = - 0. 39, - 0. 42, all P 〈 0. 01 ）. MBG was not significantly correlated with ACP （ P 〉 0. 05 ）. （4） There was no significant differences in the ACP level when HbA1 c 〈 7% , but decreased when HbAlc ≥7%. （5） Stepwise regression analysis demonstrated that MAGE firstly entered the equation and ACP was predicted by MAGE , total cholesterol, and HbAlc when ACP was regarded as dependent variable and age, diabetic duration, BMI, waist-to-hip ratio, blood pressure, MBG, MAGE, FPG, HbAlc, and blood lipid were regarded as independent variable （ adjusted R2 = 0. 305, P 〈 0.01 ）. Conclusion Glucose fluctuation deteriorates the β cell function much more than sustained hyperglycemia does.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第10期664-668,共5页
National Medical Journal of China
基金
基金项目：上海市市级医院新兴前沿技术联合攻关基金（SHDC12006101）
关键词
糖尿病
胰岛素分泌细胞
动态血糖监测
Diabetes mellitus
Insulin secreting cells
Continuous glucose monitoring
