Association between Glucose Time in Range and Carotid Artery Intima-media Thickness in Type-2 Diabetes Mellitus
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摘要:
目的 探讨2型糖尿病患者葡萄糖目标范围内时间（time in range，TIR）与颈动脉内中膜厚度（carotid artery intima-media thicknes，CIMT）的相关性。 方法 选择2型糖尿病患者232例，根据颈总动脉内中膜厚度分为2组：非正常组CIMT ≥ 0.8 cm，正常组CIMT < 0.8 cm，测量身高、体重，并检测生化指标及动态血糖参数，统计TIR值，比较2组各指标及TIR值的差异，采用Pearson相关分析CIMT与CGM指标的相关性，二元Logistic 回归分析检验CIMT与CGM指标的关系。 结果 CIMT < 0.8 cm组TIR值明显高于CIMT ≥ 0.8 cm组[（77.22±23.26） nmol/L vs （69.47±22.03） nmol/L]，且CIMT与TIR呈负相关，与SDBG、MBG、TAR呈正相关，二元Logistic回归提示TIR（P = 0.016）降低，SDBG（P = 0.025）、MBG（P = 0.006）、TAR（P = 0.014）升高是CIMT增厚的危险因素。 结论 在2型糖尿病患者中，TIR与CIMT呈负相关，TIR值降低可能是颈总动脉内中膜增厚的独立危险因素。 -
关键词:
- 动态血糖监测 /
- 葡萄糖目标范围内时间 /
- 2型糖尿病 /
- 颈动脉内中膜厚度.
Abstract:Objctive To investigate the association between glucose time in range and carotid artery intima-media thickness in type-2 diabetes mellitus. Methods A total of 232 patients with type 2 diabetes were selected and divided into two groups based on the thickness of the common carotid artery intima-media, ie CIMT ≥ 0.8 cm in the abnormal group and < 0.8 cm in the normal group. Height and weight were measured, biochemical indexes and dynamic blood glucose parameters were detected, and glucose TIR values were calculated to compare the differences of indexes and TIR values between the two groups. Pearson correlation was used to analyze the correlation between CIMT and CGM indexes. Binary Logistic regression analysis examined the relationship between CIMT and CGM indexes. Results The TIR value of CIMT < 0.8 cm group was significantly higher than that of CIMT ≥ 0.8 cm group [ （77.22±23.26） nmol/L vs （69.47±22.03） nmol/L], and CIMT was negatively correlated with TIR. TIR was positively correlated with SDBG, MBG and TAR. Binary logistic regression suggested that the decrease of TIR （P = 0.016） and the increase of SDBG （P = 0.025）, MBG （P = 0.006） and TAR （P = 0.014） were risk factors for CIMT thickening. Conclusion In patients with type 2 diabetes, there was a negative correlation between TIR and CIMT, and decreased TIR values may be an independent risk factor for thickening of the common carotid artery intima-media. -
表 1 2组一般临床资料比较（
$\bar x \pm s $ ）Table 1. Comparison of general data between two groups （
$\bar x \pm s $ ）项目 正常组（n = 63） 非正常组（n = 169） χ2/t P 年龄（岁） 50.05 ± 14.46 57.52 ± 10.31 −4.370 < 0.001* 男/女[n，（%）] 25/38（39.7/60.3） 72/97（42.6/57.4） 0.063 0.765 糖尿病病程（a） 5.77 ± 5.71 8.16 ± 7.06 −2.409 0.017* BMI（kg/m2） 23.86+3.38 24.46 ± 3.54 −1.148 0.252 TC（mmol/L） 4.30 ± 0.84 4.39 ± 1.03 −0.597 0.551 TG（mmlo/L） 1.91 ± 1.30 2.02 ± 1.64 −0.468 0.640 LDL-C（mmol/L） 2.62 ± 0.71 2.66 ± 0.91 −0.331 0.741 HDL-C（mmol/L） 1.05 ± 0.29 1.05 ± 0.26 0.025 0.980 FPG（mmol/L） 8.46 ± 3.47 8.39 ± 3.97 0.132 0.895 HbA1c（%） 8.78 ± 2.29 9.49 ± 2.47 −1.967 0.050 UA（mmol/L） 320.43 ± 96.00 348.29 ± 100.29 −1.903 0.058 SBP（mmHg） 119.57 ± 19.53 127.43 ± 20.55 −2.623 0.009* DBP（mmHg） 79.03 ± 11.82 81.77 ± 13.19 −1.444 0.150 BMI：体重指数；TC：总胆固醇；TG：甘油三脂；LDL-C：低密度脂蛋白胆固醇；HDL-C：高密度脂蛋白胆固醇；FPG：空腹血糖；HbA1c：糖化血红蛋白；UA：尿酸；SBP：收缩压；DBP：舒张压。*P < 0.05。 
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表 2 2组动态血糖参数比较（
$\bar x \pm s $ ）Table 2. Comparison of CGM parameters between two groups （
$\bar x \pm s $ ）项目 正常组（n = 63） 非正常组（n = 169） z/t P TIR（%） 77.22 ± 23.16 69.47 ± 22.03 2.351 0.020* TAR（%） 21.90 ± 23.58 29.90 ± 22.44 −3.261 0.001* TBR（%） 0.49 ± 1.43 0.67 ± 1.69 −0.760 0.448 MBG（mmol/L） 8.27 ± 1.93 9.40 ± 5.57 −1.568 0.118 MAGE（mmol/L） 5.04 ± 2.37 5.85 ± 2.22 −2.426 0.160 SDBG（mmol/L） 2.05 ± 0.81 2.34 ± 0.79 −2.522 0.120 CV（%） 24.30 ± 6.03 26.17 ± 6.97 −1.879 0.062 TIR：葡萄糖目标范围内时间；TAR：血糖高于目标范围的时间；TBR：血糖低于目标范围内的时间；MBG：平均血糖；CV：变异系数；MAGE:平均血糖波动幅度；SDBG：平均血糖标准差。*P < 0.05。
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表 3 动态血糖参数与CIMT的Pearson相关分析
Table 3. Pearson analysis between CGM parameters and CIMT between two groups
项目 相关系数 P MAGE 0.158 0.016* SDBG 0.164 0.012* TIR −0.153 0.020* TAB 0.155 0.018* *P < 0.05。
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表 4 二元Logistic回归分析
Table 4. Logistic regression analysis
项目 β OR 95%CI P TIR −0.018 0.982 0.968-0.997 0.016* SDBG 0.500 1.648 1.066-2.549 0.025* MBG 0.253 1.287 1.075-1.541 0.006* TAB 0.018 1.018 1.004-1.033 0.014* *P < 0.05。
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