Association of glycemic variability and the presence and severity of coronary artery disease in patients with type 2 diabetes
Association of glycemic variability and the presence and severity of coronary artery disease in patients with type 2 diabetes
复制标题
DOI：
10.1186/1475-2840-10-19
复制
发表时间：
2011-02-25
影响因子：
9.3
通讯作者：
Ma, Changsheng
中科院分区：
文献类型：
--
作者：
Su, Gong;Mi, Shuhua;Ma, Changsheng
背景资料：葡萄糖变异性是糖尿病代谢紊乱的组成部分之一，在糖尿病血管并发症的发生发展中可能起重要作用。本研究的目的是评估2型糖尿病（T2 DM）患者中通过连续血糖监测（CGM）系统测定的血糖变异性与冠状动脉疾病（CAD）的存在和严重程度之间的关系。在344例胸痛T2 DM患者中，冠状动脉造影显示冠状动脉狭窄≥ 50%者252例，无冠状动脉狭窄者92例。采用Gensini评分评估CAD的严重程度。结果：糖尿病合并冠心病患者年龄大，男性多，吸烟者多，糖尿病合并冠心病患者年龄大，吸烟者多。血糖波动平均幅度（法师）水平（3.7 +/- 1.4 mmol/L vs. 3.2 +/- 1.2 mmol/L，p < 0.001），餐后血糖波动（PPGE）（3.9 +/- 1.6 mmol/L vs. 3.6 +/- 1.4 mmol/L，p = 0.036），血清高敏C反应蛋白（hs-CRP）CAD患者的血肌酐（10.7 +/- 12.4 mg/L vs. 5.8 +/- 6.7 mg/L，p < 0.001）和肌酐（Cr）（87 +/- 23 mmol/L vs. 77 +/- 14 mmol/L，p < 0.001）显著高于非CAD患者。Gensini评分与年龄、法师、PPGE、HbA（1c）、hs-CRP、总胆固醇（TC）密切相关。多因素分析显示年龄（p < 0.001）、法师（p <0.001）、血清HbA（1c）（p = 0.022）和hs-CRP（p = 0.005）是Gensini评分的独立影响因素。Logistic回归分析显示法师≥ 3.4 mmol/L是冠心病的独立预测因子。法师的受试者工作特征曲线下面积（0.618，p = 0.001）上级HbA（1c）的受试者工作特征曲线下面积（0.554，p = 0.129）。血糖波动对糖尿病血管并发症的影响不容忽视。
Background: Glucose variability is one of components of the dysglycemia in diabetes and may play an important role in development of diabetic vascular complications. The objective of this study was to assess the relationship between glycemic variability determined by a continuous glucose monitoring (CGM) system and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM).Methods: In 344 T2DM patients with chest pain, coronary angiography revealed CAD (coronary stenosis >= 50% luminal diameter narrowing) in 252 patients and 92 patients without CAD. Gensini score was used to assess the severity of CAD. All participants' CGM parameters and biochemical characteristics were measured at baseline.Results: Diabetic patients with CAD were older, and more were male and cigarette smokers compared with the controls. Levels of the mean amplitude of glycemic excursions (MAGE) (3.7 +/- 1.4 mmol/L vs. 3.2 +/- 1.2 mmol/L, p < 0.001), postprandial glucose excursion (PPGE) (3.9 +/- 1.6 mmol/L vs. 3.6 +/- 1.4 mmol/L, p = 0.036), serum high-sensitive C-reactive protein (hs-CRP) (10.7 +/- 12.4 mg/L vs. 5.8 +/- 6.7 mg/L, p < 0.001) and creatinine (Cr) (87 +/- 23 mmol/L vs. 77 +/- 14 mmol/L, p < 0.001) were significantly higher in patients with CAD than in patients without CAD. Gensini score closely correlated with age, MAGE, PPGE, hemoglobin A(1c) (HbA(1c)), hs-CRP and total cholesterol (TC). Multivariate analysis indicated that age (p < 0.001), MAGE (p < 0.001), serum levels of HbA(1c) (p = 0.022) and hs-CRP (p = 0.005) were independent determinants for Gensini score. Logistic regression analysis revealed that MAGE >= 3.4 mmol/L was an independent predictor for CAD. The area under the receiver-operating characteristic curve for MAGE (0.618, p = 0.001) was superior to that for HbA(1c) (0.554, p = 0.129).Conclusions: The intraday glycemic variability is associated with the presence and severity of CAD in patients with T2DM. Effects of glycemic excursions on vascular complications should not be neglected in diabetes.