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目的采用动态血糖监测系统(CGMS)研究不同糖调节受损人群的餐后血糖波动特征。方法根据连续2次75g口服葡萄糖耐量检查(OGTT)结果,选取北京地区稳定人群中正常糖耐量(NGT)组22例,单纯空腹血糖受损(I-IFG)15例、单纯糖耐量低减(I-IGT)19例、空腹血糖受损合并糖耐量低减(IFG/IGT)组11例,新诊断2型糖尿病(T2DM)组21例。所有受试对象均行72hCGMS监测,分析比较各组餐后血糖峰值(PPG)、达峰时间(Δt),餐后血糖波动幅度(PPGE)、餐后血糖波动持续时间(DPE)、曲线下面积(AUC)和其增量(ΔAUC)。结果I-IGT、IFG/IGT和T2DM组的餐后PPG、餐后PPGE较NGT或I-IFG明显升高,I-IGT和T2DM组DPE明显延长,T2DM组Δt较NGT组明显延迟(P<0.05);从NGT、I-IGT、IFG/IGT到T2DM组,餐后血糖对全天高血糖的贡献率(ΔPAUC1)逐渐下降;且I-IFG、IFG/IGT和T2DM组较NGT有显著性差异(P<0.05);当糖化血蛋白(HbA1C)≥7%时,空腹对全天高血糖的贡献率首次逆转为大于餐后贡献率,且与HbA1C<5.5%组比较,ΔPAUC1开始有显著性差异;HbA1C与餐后总曲线下面积(AUC1)、全天总曲线下面积(AUC2)、空腹总曲线下面积(AUC3)、OGTT葡萄糖负荷后2h血糖(2hPBG)和3餐血糖峰值均值(MPPG)显著相关(r分别为0.743、0.687、0.504、0.708和0.732,P<0.001);以HbA1C为因变量,以曲线下面积和血糖水平为自变量分别进行多元逐步回归分析,只有AUC1、AUC2和2hPBG、中餐后PPG最终分别进入2个方程(决定系数r2为0.552和0.614,P<0.01)。结论IGR三组分中I-IFG的餐后特征与NGT最为接近,I-IGT组与T2DM最相似;除I-IFG组外,随着糖调节受损程度的加重,餐后血糖对全天高血糖的贡献率逐渐下降;当HbA1C<7%时,应以控制餐后血糖为主,餐后2h血糖为推荐的简单评价指标;而HbA1C≥7%时,还应重视空腹血糖。
Objective To study the characteristics of postprandial blood glucose fluctuation in different impaired glucose regulation using dynamic blood glucose monitoring system (CGMS). Methods According to the results of two consecutive oral glucose tolerance tests (OGTT) of 75 g, 22 patients with normal glucose tolerance (NGT) in stable population of Beijing were enrolled and 15 patients with impaired fasting glucose (I-IFG) 19 cases of I-IGT, 11 cases of impaired fasting glucose with impaired glucose tolerance (IFG / IGT) and 21 cases of newly diagnosed type 2 diabetes (T2DM). All subjects underwent 72hCGMS monitoring. The postprandial peak blood glucose (PPG), peak time (Δt), postprandial blood glucose fluctuation (PPGE), postprandial blood glucose fluctuation duration (DPE), area under the curve (AUC) and its increment (ΔAUC). Results Postprandial PPG and postprandial PPGE in I-IGT, IFG / IGT and T2DM groups were significantly higher than those in NGT or I-IFG groups. DPE in I-IGT and T2DM groups were significantly prolonged, while Δt in T2DM group was significantly delayed compared with NGT group (P < 0.05). The contribution rate of postprandial blood glucose to all-day hyperglycemia (ΔPAUC1) decreased from NGT, I-IGT, IFG / IGT to T2DM group, and was significantly higher than that of NGT in I-IFG, IFG / IGT and T2DM groups (P <0.05). When glycosylated hemoglobin (HbA1C) ≥7%, the contribution of fasting to whole-day hyperglycemia was reversed for the first time to be greater than the postprandial contribution rate. Compared with HbA1C <5.5%, ΔPAUC1 began to show significant difference (AUC1), total area under the curve during the day (AUC2), area under the total fasting curve (AUC3), 2hPBG after OGTT glucose load (2hPBG) and mean peak value of 3 meals ( MPPG) (r = 0.743,0.687,0.504,0.708and0.732, respectively, P <0.001). Multiple linear regression analysis was performed using HbA1C as the dependent variable and the area under the curve and the blood glucose level as independent variables. Only AUC1, AUC2 And 2hPBG respectively. After the meal, PPG finally entered two equations respectively (r2 = 0.552 and 0.614, P <0.01). Conclusion The postprandial characteristics of I-IFG among the three components of IGR are the closest to NGT, and the I-IGT group is the most similar to T2DM. Except for I-IFG group, with the aggravation of the damage of glucose regulation, When the HbA1C <7%, it should be mainly to control the postprandial blood glucose, 2h postprandial blood glucose as the recommended simple evaluation index; and HbA1C≥7%, we should attach importance to fasting blood glucose.