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目的探讨应用预混胰岛素治疗2型糖尿病后患者血糖波动与C肽之间的关系。方法选取我院内分泌科2015年3月至2016年12月住院的138例应用预混胰岛素治疗的、糖化血红蛋白(Hb A1c)波动于6. 5%9. 0%的2型糖尿病患者。所有患者均用动态血糖监测系统进行72 h血糖监测,并检测空腹C肽、餐后2 h C肽、空腹血糖、餐后2 h血糖和Hb A1c等。根据餐后2 h C肽与空腹C肽比值(C2/C0)分为A组(C2/C0 <3,n=97)和B组(C2/C0≥3,n=41),进行组间资料的比较。之后以平均血糖波动幅度和日间血糖绝对差为因变量,以性别、年龄、C2/C0比值、谷丙转氨酶、肾小球滤过率、低血糖发生与否为自变量行多元线性回归分析。结果 2组患者在性别、Hb A1c、日胰岛素总剂量、血肌酐等临床资料上差异均无统计学意义(P> 0. 05)。A组的日间血糖绝对差及平均血糖波动幅度较B组更大(P <0. 05),空腹血糖达标率高于B组(60. 9%vs 25. 8%),餐后2 h血糖达标率和低血糖发生率均低于B组(9. 8%vs 29. 9%,32. 0%vs 48. 8%)。多元线性回归结果示:在校正混杂因素后,C2/C0比值是平均血糖波动幅度的独立负相关因素(P <0. 05)。结论 2型糖尿病患者在应用预混胰岛素治疗时,要关注C2/C0,防止低血糖发生。
Abstract：AIM To explore the relationship between blood glucose fluctuation and C-peptide index in patients with type 2 diabetes mellitus. METHODS A total of 138 patients with type 2 diabetes treated with premixed insulin were recruited as the research objects from March 2015 to December 2016. Their glycosylated hemoglobin fluctuated between 6. 5% and 9. 0%. All the patients were given continuous glucose monitoring and the fasting C-peptide,2 h postprandial C-peptide,fasting blood glucose,postprandial 2 h blood glucose,glycosylated hemoglobin,liver function,renal function,serum creatinine and ALT were measured. Patients were divided into 2 groups according to the ratio of 2 h postprandial C-peptide and fasting C-peptide( C2/C0),group A( C2/C0 < 3,n = 97) and group B( C2/C0≥3,n = 41). RESULTS The comparison of gender,Hb A1 c,diurnal insulin dose and creatinine between 2 groups was made and there was no statistical difference( P > 0. 05). Means of daily differences and mean amplitude of glucose excursion were higher in group A than in group B( P < 0. 05). The control rate of the fasting blood glucose of group A was higher than that of group B( 60. 9% vs 25. 8%),while the control rate of 2 h glucose was lower in group A than that in group B( 9. 8% vs 29. 9%). The incidence of hypoglycemia in group A was lower than that in group B( 32. 0% vs 48. 8%). Multiple linear regression showed that after correcting confounding factor,C2/C0 was mean amplitude of glucose excursion independent negative correlation factors( P < 0. 05). CONCLUSION In order to preventing hypoglycemia,we should pay attention to the ratio of C2/C0 in patients with type 2 diabetes who were treated with premixed insulin.
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基本信息:
DOI：10.19577/j.1007-4406.2018.04.011
中图分类号:R587.1
引用信息:
[1]冯强,蒋翠萍,邱婕萸真,等.2型糖尿病患者应用预混胰岛素治疗后血糖波动与C肽的关系[J].中国临床药学杂志,2018,27(04):264-267.DOI:10.19577/j.1007-4406.2018.04.011.
2018-07-25
2018-07-25