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糖尿病患者HbA1c动态变异性与周围神经病变风险的相关性研究
作者:王云霞  陈杰  薛天娇  史宝娣  陈晶晶  刘静芹 
单位:保定市第一医院 内分泌科, 河北 保定 071000
关键词:2型糖尿病 糖化血红蛋白 动态变异性 糖尿病周围神经病变 相关性分析 
分类号:R587.2
出版年·卷·期(页码):2022·50·第五期(568-573)
摘要:

目的:探讨2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)动态变异性与周围神经病变发生风险的相关性。方法:选择2018年4月至2019年4月于我院就诊的T2DM患者287例。所有患者首次就诊后均进行为期3个月的HbA1c及空腹血糖(FBG)监测(每月1次),在此期间所有患者HbA1c及FGB的平均值及标准差作为动态变异性指标,并对患者进行为期2年的随访。统计首次就诊、随访1年及随访结束时患者体质指数及相关实验室检查指标,并计算出上述指标的变化(包括均值和标准差)。统计随访期间糖尿病周围神经病变(DPN)的发生情况,并根据发生情况将所有患者分为DNP组及对照组。通过COX分析影响DPN发生的危险因素。结果:截至随访结束,26例失访,最终纳入患者261例,期间共计46例患者发生DPN,最终分组为DPN组(n=46)和对照组(n=215)。DPN组患者年龄、病程及高血压占比高于对照组,差异具有统计学意义(P<0.05)。DPN组患者HbA1c-mean、HbA1c-SD、FBG-mean、FBG-SD均高于对照组患者,差异具有统计学意义(P<0.05)。COX回归分析显示,病程(HR=1.416)及HbA1c-SD (HR=49.577)是糖尿病患者DPN发生风险的独立危险因素(P<0.05)。限制性立方条图显示,随着HbA1c-SD升高,DPN发生风险呈非线性增高趋势(P=0.005)。结论:2型糖尿病患者HbA1c-SD与DPN发生风险密切相关,未来其或可用于预测患者DPN发生的风险。

Objective:To investigate the correlation between the dynamic variability of glycosylated hemoglobin(HbA1c) and the risk of peripheral neuropathy in patients with type 2 diabetes mellitus(T2DM). Methods:Two hundred and eighty-seven patients with T2DM treated in our hospital from April 2018 to April 2019 were selected. The levels of HbA1c and fast blood glucose(FBG) of the patients were determined for 3 months(once a month) after the first visit, and the average value and standard deviation of HbA1c and FGB of the patients during this period were calculated as dynamic variability indicators. The patients were subjected to a period of 2 years' follow-up. Body mass index and related laboratory examination indexes of the patients were respectively calculated at the first visit, 1 year of follow-up and the end of the follow-up, and the the value of variation in the above indexes(including the mean value and standard deviation of the difference) was calculated. Statistical analysis of the occurrence of diabetic peripheral neuropathy(DPN) during the follow-up was conducted, and all the patients were divided into DNP group and control group according to the results of analysis. The risk factors influencing the occurrence of DPN were evaluated by Cox analysis. Results:By the end of the follow-up, 261 patients who met the criteria for the study were finally included. A total of 46 patients were found to have DPN during the follow-up, and they were finally divided into DPN group(n=46) and control group(n=215). The age, course of disease and proportion of hypertension in the DPN group were higher than those in the control group, and the difference was statistically significant(P<0.05). The levels of HbA1c-mean, HbA1c-SD, FBG-mean and FBG-SD in the DPN group were higher than those in the control group with statistically significant difference(P<0.05). Multiple COX regression analysis showed that the disease courses(HR=1.416) and HbA1c-SD(HR=49.577) were independent risk factors for the development of DPN(P<0.05). Restricted cubic bar plot showed a non-linear trend of increasing risk of DPN occurrence with the increase of HbA1c-SD(P=0.005). Conclusion:HbA1c-SD is related to the occurrence of DPN in patients with T2DM, which can be used to predict the risk of DPN.

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