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目的探讨处于不同肾功能阶段的2型糖尿病(T2DM)的动态血糖及同型半胱氨酸(Hcy)变化。方法选取T2DM患者155例,按肾功能分期分为DN1组、DN2组及DN3组,比较3组的血糖波动系数及Hcy等相关指标。结果 DN1组和DN2组的Hcy水平均小于DN3组(均P<0.05),但DN1组和DN2组差异无统计学意义(P>0.05);肾小球滤过率(eGFR)与Hcy水平呈负相关(P<0.01)。DN1和DN2组间的平均血糖波动幅度(MAGE)、平均血糖(MBG)、HOMA-IR及HOMA-S差异均无统计学意义(均P>0.05),但DN1和DN2组的MAGE、MBG、HOMA-IR分别低于DN3组,HOMA-S高于DN3组(均P<0.05);e GFR与MAGE值呈负相关(P<0.01),与日间血糖平均绝对差(MODD)无相关性(P>0.05)。结论肾功能正常或肾损伤早期时的Hcy水平与动态血糖系数无明显差异,当肾功能损伤晚期时可以通过Hcy及MAGE估测肾功能损伤的情况。
Objective To investigate the dynamic changes of blood glucose and homocysteine (Hcy) in type 2 diabetes mellitus (T2DM) with different stages of renal function. Methods 155 cases of T2DM were selected and divided into DN1 group, DN2 group and DN3 group according to the stage of renal function. The blood glucose fluctuation coefficient and Hcy and other related indexes were compared between the three groups. Results The levels of Hcy in DN1 and DN2 were less than those in DN3 (all P <0.05), but there was no significant difference between DN1 and DN2 (P> 0.05). The levels of glomerular filtration rate (eGFR) and Hcy Negative correlation (P <0.01). There were no significant differences in mean blood glucose (MAGE), mean blood glucose (MBG), HOMA-IR and HOMA-S between DN1 and DN2 groups (all P> 0.05) HOMA-IR was lower than DN3 group, HOMA-S was higher than DN3 group (all P <0.05); e GFR was negatively correlated with MAGE (P <0.01), and had no correlation with daytime blood glucose mean absolute difference (P> 0.05). Conclusions There is no significant difference between Hcy levels and dynamic blood glucose level in patients with normal renal function or early stage of renal injury. Hcy and MAGE can be used to estimate renal dysfunction when the renal function is impaired.