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目的探讨2型糖尿病合并冠心病患者血糖波动的变化及对其肱动脉内皮依赖性舒张功能(FMD)的影响。方法选取近期经冠脉造影术确诊为冠心病的2型糖尿病患者30例为T2DM1组作为主要研究对象,同时选取病程、糖化血红蛋白等一般临床资料匹配的经冠脉造影术排除冠心病的2型糖尿病患者20例为T2DM2组,所有对象接受FMD检测及动态血糖监测系统(CGMS)监测。比较T2DM1组血糖波动的变化,并分析其与FMD的相关性。结果 (1)与T2DM2组相比,T2DM1组的日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、平均餐后血糖波动幅度(MPPGE)、低血糖曲线下面积(IAUC70)明显升高,差异有统计学意义(P<0.05)。(2)对T2DM1组FMD进行分析显示,FMD与MAGE、MODD、PPGE、IAUC70等血糖波动系数明显相关(P<0.05),其中与MAGE相关性最强;以FMD为因变量,各相关因素为自变量行多元逐步回归分析显示,调整其他影响因素后,MAGE仍与FMD呈负相关,且MAGE、IAUC70、收缩压均是影响FMD的独立因素。结论 2型糖尿病合并冠心病患者血糖波动较不合并冠心病患者明显增加,FMD明显受损,血糖波动与FMD受损具有相关性。
Objective To investigate the changes of blood glucose in patients with type 2 diabetes mellitus complicated with coronary heart disease and its effects on the brachial artery endothelium-dependent diastolic function (FMD). Methods Thirty patients with type 2 diabetes mellitus who were diagnosed as CHD by coronary angiography were selected as the main study subjects. At the same time, the type 2 diabetes mellitus patients with coronary heart disease who underwent coronary angiography, such as course of disease and glycosylated hemoglobin, Twenty patients with diabetes were T2DM2 group, all subjects were monitored by FMD and dynamic glucose monitoring system (CGMS). The changes of blood glucose in T2DM1 group were compared and their correlation with FMD was analyzed. Results (1) Compared with T2DM2 group, the intraday mean blood glucose fluctuation (MAGE), mean daytime blood glucose (MODD), mean postprandial blood glucose fluctuation (MPPGE), hypoglycemic curve area (IAUC70) Was significantly higher, the difference was statistically significant (P <0.05). (2) The analysis of FMD in T2DM1 group showed that there was a significant correlation between FMD and MAGE, MODD, PPGE, IAUC70 and other blood glucose fluctuation coefficients (P <0.05), of which the correlation with MAGE was the strongest. The FMD as dependent variable, Multivariate stepwise regression analysis showed that MAGE remained negatively correlated with FMD after other factors were adjusted, and MAGE, IAUC70 and systolic blood pressure were independent factors affecting FMD. Conclusions Patients with type 2 diabetes mellitus and coronary heart disease have significantly higher blood glucose fluctuations than those without coronary artery disease. FMD is significantly impaired. Fluctuation of blood glucose is associated with impaired FMD.