彭永等

[摘要] 目的 探讨糖尿病合并下肢血管病变（DLEAD）患者血糖波动与踝肱指数（ABI）及8-异前列腺素F2α（8-iso-PGF2α）的相关性。 方法 选择2013年9月～2014年2月北京军区总医院内分泌科收治的60例2型糖尿病（T2DM）患者，依据超声检查结果分为单纯2型糖尿病组（DM组），合并下肢血管病变组（DLEAD组），另选取健康者20例做为对照组（NC组）。分别检测其血压、血脂、糖化血红蛋白（HbA1c）、8-iso-PGF2α、ABI等指标。应用动态血糖监测仪对各组行连续72 h血糖监测，采用全天血糖标准差（SDBG）、日内平均血糖波动幅度（MAGE）、全天有效血糖波动次数（FGE）、日间血糖平均绝对差（MODD）4个指标评价血糖波动，比较三组间ABI、8-iso-PGF2α及各血糖波动参数，并分析血糖波动参数及临床生化指标与ABI、8-iso-PGF2α的相关性。 结果 ①DLEAD组患者的病程、MAGE、MODD、SDBG、FGE、8-iso-PGF2α较DM组均明显升高，差异均有统计学意义（P < 0.05）；DLEAD组ABI明显低于DM组，差异有统计学意义（P < 0.05）。②采用Pearson相关分析表明：MAGE、FGE、MODD与ABI呈负相关（r = -0.802、-0.147、-0.553，P < 0.05）；MAGE、MODD与8-iso-PGF2α呈正相关（r = 0.825、0.504，P < 0.05）。多因素逐步回归分析发现：MAGE、FGE、MODD与ABI独立相关（Y = 1.26 - 0.046 MAGE-0.017 FGE-0.042 MODD）。 结论 血糖波动与DLEAD密切相关，可能是通过诱发氧化应激水平引起及加重DLEAD。

[关键词] 2型糖尿病；下肢血管病变；血糖波动；8-异前列腺素F2α

[中图分类号] R587.1 [文献标识码] A [文章编号] 1673-7210（2014）11（c）-0039-04

Relationship between blood fluctuations with ankle-brachial index and 8-iso-prostaglandin 2α in type 2 diabetes patients with lower extremity vascular disease

PENG Yong1 LU Xiaofeng1 CHENG Qianpeng2 ZHAO Jing2 WU Jinxiao2 DING Lin2 CHEN Shaomin2 MA Yanxia2

1.Clinical College， General Hospital of Beijing Military Command Affiliated to Anhui Medical University， Beijing 100700， China； 2.Department of Endocrinology， General Hospital of Beijing Military Command， Beijing 100700， China [Abstract] Objective To investigate the relationship between the blood glucose fluctuations with ankle-brachial index （ABI） and 8-iso-prostaglandin 2α （8-iso-PGF2α） in type 2 diabetes patients （T2DM） with lower extremity vascular disease. Methods From September 2013 to February 2014， in Department of Endocrinology of General Hospital of Beijing Military Command， 60 patients with T2DM undergone ultrasound scan were selected， 30 cases not merged with lower extremity vascular diabetes were as DM group， 30 cases merged with lower extremity vascular disease wete as DLEAD group， and 20 healthy people were as controls （group NC）. All the participants were monitored continuous glucose monitoring system （CGMS） for 72 hours to evaluate CGMS parameters such as mean amplitude of glycemic excursions （MAGE）， standard deviation of blood glucose （SDBG）， effective blood glucose fluctuations in frequency （FGE）， absolute means of daily differences （MODD）. The levels of 8-iso-PGF2α， ABI， blood pressure， blood fat， glycated hemoglobin （HbA1c） were detected. Then above-mentioned index were compared between the three groups. The correlation was analyzed between the clinical biochemical， parameters with ABI， 8-iso-PGF2α. Results ①The levels of disease duration， MAGE， MODD， SDBG， FGE， 8-iso-PGF2α in DLEAD group were significantly higher than those in DM group， the differences were statistically significant （P < 0.05）. The ABI of DLEAD group was statistically lower than that of the DM group. ②Pearson correlation analysis showed that： MAGE， MODD were positively related to 8-iso-PGF2α （r = -0.802， -0.147， -0.553， P < 0.05）. MAGE， FGE， MODD was negatively correlated with ABI （r = 0.825， 0.504， P < 0.05）. Multiple stepwise regression analysis indicated that MAGE， FGE， MODD were dependent risk to ABI （Y = 1.26-0.046MAGE-0.017FGE-0.042MODD）. Conclusion Blood glucose fluctuations are closely correlated with DLEAD， and it may cause or aggravata DLEAD by inducing oxidative stress.

[Key words] Type 2 diabetes mellitus； Lower extremity vascular disease； Blood glucose fluctuations； 8-iso-PGF2α

糖化血红蛋白（HbA1c）是反映糖尿病（DM）患者血糖长期控制情况的金标准。国外研究报道[1]，即使HbA1c控制达标，DM大血管病变风险也未明显降低。在相同HbA1c的DM患者中，血糖波动明显者血管并发症的发生率明显升高[2]。动态血糖监测系统（CGMS）随着近年来不断被完善，可以提供更具说服力和充分的血糖监测数据[3]。氧化应激在T2DM发病机制中的作用已被愈来愈多的证据所支持[4]，尤其不稳定性的高血糖诱导的氧化应激可能会加重2型糖尿病（T2DM）大血管病变的进展。8-iso-PGF2α被认为是评价体内氧化应激的金指标[5]。踝肱指数（ABI）是2010版DM防治指南中提出的目前诊断糖尿病并发下肢血管病变（diabetic lower extremity arterial disease，DLEAD）的标准；……