作者：王一平,徐辉,白宏英

单位：

450014 河南省郑州市，郑州大学第二附属医院神经内科 通信作者：白宏英，E-mail：hybai@126.com

Units：

Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China Corresponding author: BAI Hongying, E-mail: hybai@126.com

关键词：

糖尿病,2型; 脑血管障碍; 连续血糖监测; 葡萄糖; 目标范围内时间; 总体负担;

Keywords：

Diabetes mellitus, type 2; Cerebrovascular disorders; Continuous blood glucose monitoring; Glucose;Time in range; Total burden

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.278

Funds：

河南省医学科技攻关计划项目（LHGJ20190314）

摘要：

背景葡萄糖目标范围内时间(TIR)是最新的血糖管理参考指标,由连续血糖监测(CGM)获得,与糖尿病血管并发症有关。脑小血管病(CSVD)是2型糖尿病患者常见的脑血管并发症之一。目前临床对TIR与CSVD的关系尚不明确。目的 探讨2型糖尿病并CSVD患者TIR与CSVD总体负担的关系。方法 选取2019年12月至2021年3月郑州大学第二附属医院神经内科与内分泌科收治的2型糖尿病并CSVD患者151例,根据CSVD总体负担评分将其分为低负担组(CSVD总体负担评分为0～2分)96例和高负担组(CSVD总体负担评分为3～4分)55例。比较两组患者的一般资料、TIR。采用多因素Logistic回归分析探讨2型糖尿病并CSVD患者CSVD总体负担的影响因素。采用Spearman秩相关分析探讨TIR与2型糖尿病并CSVD患者CSVD总体负担评分的相关性。比较不同TIR患者CSVD高负担发生率。结果 高负担组患者年龄大于低负担组,高血压发生率、入院时收缩压、血尿酸、糖化血红蛋白(HbA1c)高于低负担组,糖尿病病程长于低负担组,TIR低于低负担组(P <0.05)。多因素Logistic回归分析结果显示,年龄〔OR=1.289,95%CI(1.085,1.530)〕、血尿酸〔OR=1.008,95%CI(1.002,1.013)〕、TIR〔OR=0.910,95%CI(0.873,0.948)〕是2型糖尿病并CSVD患者CSVD总体负担的独立影响因素(P <0.05)。Spearman秩相关分析结果显示,TIR与2型糖尿病并CSVD患者CSVD总体负担评分呈负相关(rs=-0.537,P <0.001)。按照TIR四分位数将患者分为1组(TIR≤67%)40例,CSVD高负担发生率为75.0%(30/40);2组(TIR为68%～82%)36例,CSVD高负担发生率为33.3%(12/36);3组(TIR为83%～90%)38例,CSVD高负担发生率为21.1%(8/38);4组(TIR≥91%)37例,CSVD高负担发生率为13.5%(5/37)。CSVD高负担发生率随2型糖尿病并CSVD患者TIR升高呈递减趋势(χ2趋势=32.702,P <0.001)。结论 TIR降低是2型糖尿病并CSVD患者CSVD高负担的独立危险因素,CSVD高负担发生率随2型糖尿病并CSVD患者TIR升高而递减。

Abstract：

【Abstract】　Background Time in range (TIR) is the latest reference index of blood glucose management, andoriginated from continuous glucose monitoring (CGM) , which is related to diabetic vascular complications. Cerebral small vesseldisease (CSVD) is one of the cerebrovascular complications of patients with type 2 diabetes mellitus. At present, the clinicalrelationship between TIR and CSVD is not clear. Objective To explore the relationship between TIR and the CSVD total burdenin type 2 diabetes mellitus patients complicated with CSVD.MethodsA total of 151 type 2 diabetes mellitus patients combinedwith CSVD in Department of Neurology and Department of Endocrine of the Second Affiliated Hospital of Zhengzhou Universityfrom December 2019 to March 2021 were selected as the study subjects. The patients were divided into low burden group (0-2scores, n=96) and high burden group (3-4 scores, n=55) according to CSVD total burden score. General data, TIR were comparedbetween the two groups. Multivariate Logistic regression analysis was used to explore the influencing factors of CSVD total burdenin type 2 diabetes mellitus patients complicated with CSVD. Spearman rank correlation analysis was used to explore the correlationbetween TIR and CSVD total burden in type 2 diabetes mellitus patients complicated with CSVD. The incidence of high CSVDburden was compared in patients with different TIR. Results Age in high burden group was older than that in low burden group,incidence of hypertension, systolic blood pressure at admission, blood uric acid, glycosylated hemoglobin (HbA1c) were higher thanthose in low burden group, course of diabetes was longer than that in low burden group, TIR was lower than that in low burdengroup (P < 0.05) . Multivariate Logistic regression analysis results showed that, age [OR=1.289, 95%CI (1.085, 1.530) ] , blooduric acid [OR=1.008,95%CI (1.002, 1.013) ] , TIR [OR=0.910, 95%CI (0.873, 0.948) ] were independent influencing factors ofCSVD total burden in type 2 diabetes mellitus patients complicated with CSVD (P <0.05) . Spearman rank correlation analysisresults showed that, TIR was negative correlation with CSVD total burden score in type 2 diabetes mellitus patients complicatedwith CSVD (rs=-0.537, P < 0.001) . According to TIR quartile, patients were divided into group 1 (TIR ≤ 67%) with 40 cases,incidence of high CSVD burden was 75.0% (30/40) ; group 2 (TIR was 68%-82%) with 36 cases, incidence of high CSVDburden was 33.3% (12/36) ; group 3 (TIR was 83%-90%) with 38 cases, incidence of high CSVD burden was 21.1% (8/38) ;group 4 (TIR ≥ 91%) with 37 cases, incidence of high CSVD burden was 13.5% (5/37) . The incidence of high CSVD burdendecreased with the increase of TIR in type 2 diabetes mellitus patients complicated with CSVD (χ2 tendency=32.702, P < 0.001) .Conclusion Decreased TIR is an independent risk factor for the increase of high CSVD burden in type 2 diabetes mellituspatients complicated with CSVD, and the incidence of high CSVD burden decreased with the increase of TIR in type 2 diabetesmellitus patients complicated with CSVD.

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