血糖波动的意义及临床评估方法

:,150086:[e-mail]李强,李鹏杰:1005-2194(2009)09-0876-03:R5:A:越来越多的证据显示,血糖波动独立于糖化血红蛋白(HbA1c),可能与糖尿病并发症显著相关本文从日内血糖波动日间血糖波动进餐相关性血糖波动严重低血糖危险等4个方面介绍评估血糖波动的方法日内血糖波动的评估指标包括血糖水平的标准差(SDBG)血糖波动于某一范围的时间百分比曲线下面积或频数分布最大血糖波动幅度(LAGE)M-值平均血糖波动幅度(MAGE);日间血糖波动的评估指标包括空腹血糖变异系数(FPG-CV)和日间血糖平均绝对差(MODD);餐后血糖波动的评估指标包括平均进餐波动指数(MIME)和餐后血糖的时间与曲线下面积增值(IAUC);严重低血糖危险的评估指标为低血糖指数(LBGI)临床上应根据各参数特点和评估目的进行合理选择:血糖波动;日内血糖波动;日间血糖波动;进餐相关性血糖波动Theclinicalsignificanceandassessmentmethodsofglucosefluctuation.LIQiang,LIPeng-jie.DepartmentofEndocrinology&Metabolism,theSecondAffiliatedHospitalofHarbinMedicalUniversity,Harbin150086,ChinaSummary:Moreandmoreevidenceshowsthatglucosefluctuation,independentofHbA1c,mayplayasignificantroleintheriskfordiabetescomplications.Thepurposeofthisarticleistointroducetheassessmentofglycemicfluctuationinfouraspects,suchaswithin-daybloodglucoseexcursions,day-to-daybloodglucoseexcursions,postprandialbloodglucoseex-cursions,andtheriskofserioushypoglycemia.Theindexesforassessmentofwithin-daybloodglucoseexcursionscontainstandarddeviationofbloodglucose(SDBG),timepercentageofbloodglucoseexcursionsinacertainrange,areaunderthecurveorfrequencydistribution,thelargestamplitudeofglycemicexcursions(LAGE),M-value,andmeanamplitudeofglycemicexcursions(MAGE);theindexesforassessmentofday-to-daybloodglucoseexcursionscontainfastingplasmaglucose-coefficientvariation(FPG-CV),andabsolutemeansofdailydifferences(MODD);theindexesforassessmentofpostprandialbloodglucoseexcursionscontainmeanindicesofmealexcursions(MIME)andincreaseareaunderthecurve(IAUC);theindexesforassessmentoftheriskofserioushypoglycemiacontainlowbloodglucoseindex(LBGI).RationalchoicesshouldbemadeaccordingtothefeatureofeveryindexandtheaimofassessmentinClinicians.Keywords:glucosefluctuation;within-daybloodglucoseexcursions;day-to-daybloodglucoseexcursions;postprandialbloodglucoseexcursions李强,教授主任医师医学博士博士研究生导师现任哈尔滨医科大学附属二院内分泌代谢病科主任兼任中华医学会内分泌学会委员中华医学会糖尿病学会中青年委员中国医师协会内分泌代谢科医师分会常委,5中华糖尿病杂志65中国实用内科杂志6等杂志编委,(HbA1c)(DM),HbA1cDM,HbA1c,DM[1]1Lachin[2]HbA1c,HbA1c(7%8%9%11%),;7~9HbA1c9%18%,6%~7%,Derr[3],,HbA1cHbA1c,HbA1cDM,876ChineseJournalofPracticalInternalMedicineSep.2009Vo.l29No.9,,,,(AGEs)C(PKC),,,Risso(5mmol/L)(20mmol/L)(520mmol/L)(HUVECs),14dHUVECsTemelkova-Kurk-tschiev58240~70DM(PGS)(IMT),,PGSIMT,Muggeo(FPG)2(T2DM),,PPGDM,(CGMS)T1DM,HbA1c[(717?114)%]FPG,90%10mmol/L,50%1617mmol/L,70%PREDICTIVE,FPGFPGT2DM2,:(1);(2);(3);(4)211:(SDBG)(LAGE)M-(MAGE)21111(SDBG)[4],,,,,21112,DMDM718mmol/L319~718mmol/L319mmol/L,,21113,,,21114(LAGE),,DM21115MSchlichtkrill2060,Mirouze,SclichtkrullM,M=r|10log10(BG/5)|3/N+W/20,N,WLAGE21116(MAGE)ServiceMAGEDM24hSDBG,(1SDBG),,(NGE)(MAGE)015110115SDBG,1SDBGNGR1SDBG/0212(FPG-CV)(MODD)21211(FPG-CV),FPGPPG,,CV,21212(MODD)2d,,MODD(lipohypertrophy)213(MIME)(IAUC)21311(MIME)(PPGE)(vt)1h(BR)21312(IAUC),,0~5h,LAUC(0~2h)(877200992992~5h)IAUC214(SH)SH(LBGI)M-,,Trans(BG)=11794@{[ln(BG)]11026-11861},Trans(BG),Trans(BG)0,Risk(BG)=10[Trans(BG)]2;Trans(BG)\0,Risk(BG)=0LBGIRisk(BG)LBGIDM(LBGI215)(LBGI215~5)(LBGI5)3,SH016213512(P01001)LBGISH40%SH,HbA1c4,,SH3MAGE,SDBG,LAGEMODD,,2dFPG-CV,FPG319~516mmol/L10min1h([718mmol/L),2~3h2~3mmol/L,5,018mmol/L[5]CGMST2DMT2DMMAGE[(2131?0151)mmol/L(1195?0155)mmol/L,P0105],BMBCIT2DM[35198(15172~59156)17164(16192~50100),P0105],T2DMB,B,T2DM,,MAGE,DMDM,,3;,215;,,,T2DM,,[6]8CGMS2h3,,CGMS288,,,DM(DirecNet)Fiallo-Scharer[10]2007~181DM,CGMS8CGMS,,,HbA1c,DMDMHbA1c,,,DM[1]HirschIB.Glycemicvariability:itpsnotjustaboutA1Canymore[J].DiabetesTechnolTher,2005;7(5):780-783.[2]LachinJM,GenuthS,NathanDM,eta.lEffectofglycemicexpo-sureontheriskofmicrovascularcomplicationsinthediabetescon-trolandcomplicationstria-lrevisited[J].Diabetes,2008;57(4):995-1001.[3]DerrR,GarrettE,StacyGA,eta.lIsHbA(1c)affectedbyglyce-micinstability?[J].DiabetesCare,2003,26(10):2728-2733.[4]McCarterRJ,HempeJM,ChalewSA.Meanbloodglucoseandbio-logicalvariationhavegreaterinfluenceonHbA1clevelsthanglu-coseinstability:ananalysisofdatafromthediabetescontrolandcomplicationstrail[J].DiabetesCare,2006,29(2):352-355.[5],,,.2[J].,2009,89(10):655-658.[6],,,.[J].,2006,14:970-975.2009-03-22:878ChineseJournalofPracticalInternalMedicineSep.2009Vo.l29No.9