血糖变异性对2 型糖尿病合并冠心病患者近期心血管事件的影响
| 作者: |
1刘婕,
1袁园,
1张文博,
1付留俊
1 河南科技大学第一附属医院内分泌科，河南 洛阳 471003 |
| 通讯: |
刘婕
Email: hlu1973@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.06.014 |
摘要
目的：分析血糖变异性对2型糖尿病(type2 diabetes mellitus，T2DM)合并冠心病患者近期心血管事件的影响。方法：选取2015年6月至2018年4月河南科技大学第一附属医院收治的T2DM患者120例为研究对象，依据冠状动脉造影结果将其分为对照组(单纯糖尿病，n=48)、观察组(糖尿病合并冠心病，n=72)，记录入院72 h动态血糖监测结果，对比其一般资料、空腹血糖(FPG)及糖化血红蛋白(HbA1c)水平、血糖变异性参数[全天血糖平均值(mean blood glucose，MBG)、日内最大血糖波动幅度(largest amplitude of glycemic excursion，LAGE)、全天血糖标准差(standard deviation of blood glucose，SDBG)、日间血糖平均绝对差(mean of daily differences，MODD)、平均餐后血糖漂移幅度(mean postprandial glucose excursion，MPPGE)、空腹血糖变异系数(coefficient of variation of fasting plasma glucose，CV-FPG)]、心血管事件的差异，分析各指标对近期心血管事件的风险比。结果：观察组FPG，HbA1c、尿酸、超敏C反应蛋白(hs-CRP)水平高于对照组，左室射血分数(left ventricular ejection fraction，LVEF)低于对照组(P<0.05)，而其他资料比较差异无统计学意义(P>0.05)；观察组LAGE，SDBG，MODD，MPPGE，CV-FPG高于对照组(P<0.01)，两组MBG比较差异无统计学意义(P>0.05)；观察组近期心血管事件发生率高于对照组(P<0.05)；Cox回归分析显示，随诊期间HbA1c，FPG水平及LAGE，SDBG，MODD，MPPGE，CV-FPG均影响T2DM合并冠心病患者近期心血管事件的发生(P<0.05)，尤其是LAGE，MODD，MPPGE的影响程度更大(P<0.01)。结论：血糖变异性可影响T2DM合并冠心病患者近期心血管事件的发生，应加以监测。
关键词：
血糖变异性；2型糖尿病；冠心病；心血管事件
Effect of glucose variability on recent cardiovascular events in patients with type 2 diabetes mellitus combined with coronary heart disease
CorrespondingAuthor: LIU Jie Email: hlu1973@126.com
DOI: 10.3978/j.issn.2095-6959.2019.06.014
Abstract
Objective: To analyze the effect of glucose variability on recent cardiovascular events in patients with type 2 diabetes mellitus (T2DM) combined with coronary heart disease. Methods: A total of 120 patients with T2DM in the hospital from June 2015 to April 2018 were selected as the study subjects. According to the results of coronary angiography, they were divided into control group (diabetes mellitus, n=48) and observation group (diabetes mellitus combined with coronary heart disease, n=72). The results of continuous glucose monitoring in 72 h after admission were recorded. The general data, fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) levels, glucose variability parameters [mean blood glucose (MBG), largest amplitude of glycemic excursion (LAGE), standard deviation of blood glucose (SDBG), means of daily differences (MODD), mean postprandial glucose excursion (MPPGE), coefficient of variation of fasting plasma glucose (CV-FPG)] and differences in cardiovascular events were compared between the two groups. The risk ratio of each indicator to recent cardiovascular events was analyzed. Results: The levels of FPG, HbA1c, uric acid and high-sensitivity C-reactive protein (hs-CRP) in the observation group were higher than those in the control group, while LVEF was lower than that in the control group (P<0.05). There was no significant difference in other data between the two groups (P>0.05). The LAGE, SDBG, MODD, MPPGE and CV-FPG in the observation group were higher than those in the control group (P<0.01). There was no significant difference in MBG between the two groups (P>0.05). The incidence of recent cardiovascular events in the observation group was higher than that in the control group (P<0.05). Cox regression analysis showed that HbA1c and FPG levels, LAGE, SDBG, MODD, MPPGE and CV-FPG affected the occurrence of recent cardiovascular events in patients with T2DM and coronary heart disease during follow-up (P<0.05). In particular, the effect degree of LAGE, MODD and MPPGE was greater (P<0.01). Conclusion: Glucose variability can affect the occurrence of recent cardiovascular events in patients with T2DM and coronary heart disease. It should be monitored.
Keywords：
glucose variability; type 2 diabetes mellitus; coronary heart disease; cardiovascular event