[1]罗 云,何高芬,郭 庆.T2DM患者葡萄糖目标范围内时间和HbA1c检测对糖尿病大血管病变的预测价值分析[J].现代检验医学杂志,2025,40(04):164-168.[doi:10.3969/j.issn.1671-7414.2025.04.029]
　LUO Yun,HE Gaofen,GUO Qing.Predictive Value of Time Within the Target Range of Glucose and HbA1c Detection in T2DM Patients for Macroangiopathy in Diabetes[J].Journal of Modern Laboratory Medicine,2025,40(04):164-168.[doi:10.3969/j.issn.1671-7414.2025.04.029]
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T2DM患者葡萄糖目标范围内时间和HbA1c检测对糖尿病大血管病变的预测价值分析()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年04期
页码:
164-168
栏目:
论著
出版日期:
2025-07-15

文章信息/Info

Title:
Predictive Value of Time Within the Target Range of Glucose and HbA1c Detection in T2DM Patients for Macroangiopathy in Diabetes
文章编号:
1671-7414（2025）04-164-05
作者:
罗 云，何高芬，郭 庆
（上海市嘉定区安亭医院内分泌科，上海 201805）
Author(s):
LUO Yun，HE Gaofen, GUO Qing
(Department of Endocrinology, Anting Hospital in Jiading District, Shanghai 201805, China)
关键词:
葡萄糖目标范围内时间; 糖化血红蛋白; 2 型糖尿病; 糖尿病大血管病变
分类号:
R587.2；R446.112
DOI:
10.3969/j.issn.1671-7414.2025.04.029
文献标志码:
A
摘要:
目的 分析葡萄糖目标范围内时间（TIR）、糖化血红蛋白（HbA1c）对2型糖尿病（T2DM）患者糖尿病大血管病变的预测价值。方法 选定上海市嘉定区安亭医院2022 年2 月~2024 年2 月就诊的110 例T2DM患者，根据是否并发糖尿病大血管病变将其分为病变组(n=42) 和未病变组（n=68)，比较两组TIR和HbA1c，Logistic回归分析T2DM并发糖尿病大血管病变的危险因素，绘制受试者工作特征曲线（ROC）分析TIR，HbA1c对T2DM并发糖尿病大血管病变的预测效能。结果与未病变组比较，病变组TIR（50.64%±3.62 % vs 69.82%±5.14 %）降低，HbA1c（9.02%±1.16% vs 7.29%±1.08%）升高，差异具有统计学意义（t=21.144，7.934，均P<0.001）。TIR，HbA1c，吸烟史、收缩压（SBP）、低密度脂蛋白胆固醇（LDL-C）是T2DM患者并发糖尿病大血管病变的危险因素（Waldχ2=5.648~10.516，均P＜ 0.05）。TIR，HbA1c最佳临界值分别取59.32%，8.26%时，TIR，HbA1c联合预测T2DM患者并发糖尿病大血管病变的曲线下面积（AUC）大于单一指标检测，差异具有统计学意义（Z= 2.728，2.306，均P＜0.05）。结论 TIR降低、HbA1c增高与T2DM患者并发糖尿病大血管病变联系密切，可能是T2DM患者并发糖尿病大血管病变的危险因素。联合检测TIR，HbA1c可提高对糖尿病大血管病变的预测灵敏度。
Abstract:
Objective To analyze the predictive value of time within the target range of glucose (TIR) and glycosylated hemoglobin (HbA1c) in type 2 diabetes (T2DM) patients with macroangiopathy. Methods 110 T2DM patients in Anting Hospital, Jiading District, Shanghai from February 2022 to February 2024 were selected. They were divided into two groups according to whether they were complicated with diabetes macroangiopathy. 42 patients with diabetes macroangiopathy were set as the lesion group, and 68 patients without diabetes macroangiopathy were set as the non lesion group. The TIR and HbA1c of the two groups were compared to analyze the risk factors of T2DM complicated with diabetes macroangiopathy by Logistic regression, draw the receiver operating characteristic curve (ROC), and analyze the predictive efficacy of TIR and HbA1c on T2DM complicated with diabetes macroangiopathy. Results Compared with the non diseased group, the TIR of the diseased group (50.64% ± 3.62% vs 69.82% ± 5.14%) decreased, while HbA1c (9.02% ± 1.16% vs 7.29% ± 1.08%) increased, with statistically significant differences (t=21.144, 7.934, all P<0.001). TIR, HbA1c, smoking history, systolic pressure (SBP) , low density lipoprotein cholesterol (LDL-C) could be a risk factor for T2DM patients complicated with diabetes macroangiopathy (Waldχ2=5.648~10.516, all P<0.05). When the optimal threshold value of TIR and HbA1c were 59.32% and 8.26%, respectively, the area under curve (AUC) predicted by TIR and HbA1c jointly for T2DM patients with diabetes macroangiopathy which was greater than that by a single test with statistically significant difference (Z=2.728, 2.306, all P<0.05). Conclusion The decrease of TIR and the increase of HbA1c are closely related to diabetes macroangiopathy in T2DM patients, and they may be a risk factor for T2DM patients complicated with diabetes macroangiopathy. The combined detection of TIR and HbA1c can improve the prediction sensitivity of diabetes macroangiopathy.

参考文献/References:

[1] 李凌, 王成, 王静, 等.2 型糖尿病微血管并发症患者血清miR-152,β2-GPI/ox-LDL 和β2-GP Ⅰ -Lp(a) 水平联合检测的价值研究[J]. 现代检验医学杂志,2021,36(2):61-65. LI L, WANG C, WANG J, et al. Clinical value of combined retention of serum miR-152,β2-GPI/ox-LDL andβ2-GP Ⅰ -Lp(a)in the type 2 diabetes patients with microvascular complications[J]. Journal of Modern Laboratory Medicine, 2021, 36(2): 61-65.
[2] 夏翠萍, 岳菊, 乔叶红, 等. 血清CTRP1, FGF21 和ANGPTL3 水平在2 型糖尿病大血管病变中的诊断价值[J]. 检验医学与临床,2023,20(14):2006-2011. XIA C P, YUE J, QIAO Y H, et al. Diagnostic value of serum CTRP1,FGF21,and ANGPTL3 levels in macrovascular disease in type 2 diabetes[J]. Laboratory Medicine and Clinic, 2023, 20(14): 2006-2011.
[3] 姜艳, 岳月仪, 吴滨, 等. 转化生长因子-β 和镍纹样蛋白与2 型糖尿病大血管病变的相关性[J]. 实用临床医药杂志,2023,27(5):92-96, 103. JIANG Y, YUE Y Y, WU B, et al. Associations of transforming growth factor-βand meteorin-like protein with macroangiopathy in type 2 diabetes mellitus[J]. Journal of Clinical Medicine in Practice, 2023, 27(5): 92-96, 103.
[4] 唐青青, 郭英, 张广栋, 等. 葡萄糖目标范围内时间和糖化血红蛋白水平与糖尿病视网膜病变风险的相关性研究[J]. 中华眼底病杂志,2022,38(1):20-26. TANG Q Q, GUO Y, ZHANG G D, et al. Study on the correlation between the time within the glucose target range,the level of glycosylated hemoglobin and the risk of diabetic retinopathy[J]. Chinese Journal of Ocular Fundus Diseases, 2022, 38(1): 20-26.
[5] 王彦, 周洪兴, 鲁科峰, 等.25- 羟维生素D 和糖化血红蛋白水平与2 型糖尿病外周血管病变的相关性分析[J]. 临床检验杂志,2023,41(1):60-63. WANG Y, ZHOU H X, LU K F, et al. Correlation analysis of 25-hydroxy vitamin D and glycosylated hemoglobin with peripheral vascular disease in type 2 diabetes mellitus[J]. Chinese Journal of Clinical Laboratory Science, 2023, 41(1): 60-63.
[6] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等.2 型糖尿病基层诊疗指南(实践版2019) [J]. 中华全科医师杂志,2019,18(9):810-818. Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Practice, et al. Guideline for primary care of type 2 diabetes:practice version(2019)[J]. Chinese Journal of General Practitioners, 2019, 18(9): 810-818.
[7] 蒋俊兰, 刘尚全, 汪奇. 糖化血红蛋白变异指数对糖尿病大血管病变风险的评估价值[J]. 标记免疫分析与临床,2020,27(12):2092-2096. JIANG J L, LIU S Q, WANG Q. The evaluation value of hemoglobin glycation index for the risk of diabetic macroangiopathy[J]. Labeled Immunoassays and Clinical Medicine, 2020, 27(12): 2092-2096.
[8] DENG Z X, WANG S Y, LU J Y, et al. Interaction between haptoglobin genotype and glycemic variability on diabetic macroangiopathy: a population-based crosssectional study[J]. Endocrine, 2023, 82(2): 311-318.
[9] 周海侠, 方开峰, 朱军. 老年2 型糖尿病大血管病变患者颈动脉IMT 与血浆Hcy, IL-17, NGAL 表达的关系[J]. 河北医科大学学报,2022,43(5):608-613. ZHOU H X, FANG K F, ZHU J. The relationship between IMT in the carotid artery and the expression of plasma Hcy,IL-17,NGAL in elderly patients with type 2 diabetes mellitus and macrovascular disease[J]. Journal of Hebei Medical University, 2022, 43(5): 608-613.
[10] 王然, 崔国利, 李雅江. 血清内皮细胞特异分子-1、脂肪特异性丝氨酸蛋白酶抑制剂水平对2 型糖尿病大血管病变诊断的临床价值[J]．实用临床医药杂志，2021,25(3):103-106. WANG R, CUI G L, LI Y J. Values of serum endothelial cell specific molecule-1 and visceral adipose tissuederived serine protease inhibitor levels in the diagnosis of type 2 diabetic macroangiopathy[J]. Journal of Clinical Medicine in Practice, 2021, 25(3): 103-106.
[11] 中华医学会糖尿病学分会. 葡萄糖目标范围内时间(TIR)成为国际共识新推荐[J].糖尿病之友,2019 (5):9. Chinese Diabetes Society. Time within glucose target range (TIR) has become a new international consensus recommendation[J]. Friends of Diabetes, 2019(5): 9.
[12] 李海, 李延兵.《葡萄糖目标范围内时间国际共识》解读[J]. 中华糖尿病杂志,2019,11(12):825-827. LI H, LI Y B. Interpretation of the international consensus on time in range glucose targets[J]. Chinese Journal of Diabetes Mellitus, 2019, 11(12): 825-827.
[13] 王珍珍, 曹永红, 戴武. 葡萄糖在目标范围内时间与2 型糖尿病患者心脏自主神经病变的相关性研究[J].安徽医学,2022,43(4):386-390. WANG Z Z, CAO Y H, DAI W. Relationship between time in rangeand diabetic cardiac autonomic neuropathy in patients with type 2 diabetes[J]. Anhui Medical Journal, 2022, 43(4): 386-390.
[14] 王亚昕, 陆静毅, 戴冬君, 等.2 型糖尿病患者葡萄糖在目标范围内时间与视网膜病变相关性的队列研究[J]. 中华糖尿病杂志,2021,13(11):1061-1067. WANG Y X, LU J Y, DAI D J, et al. Association between time in range and diabetic retinopathy among patients with type 2 diabetes mellitus: a cohort study[J]. Chinese Journal of Diabetes Mellitus, 2021, 13(11): 1061-1067.
[15] 王铭, 奚志, 孟启哲, 等. 血糖变异性和葡萄糖目标范围内时间与急性缺血性脑卒中合并糖尿病患者早期神经功能恶化的相关性研究[J]. 中国全科医学,2022,25(12):1418-1423. WANG M, XI Z, MENG Q Z, et al. Correlation of glycemic variability and time in range with early neurological deterioration in patients with acute ischemic stroke and diabetes[J]. Chinese General Practice, 2022, 25(12): 1418-1423.
[16] 王丹钰, 邓欣如, 史晓阳, 等.2 型糖尿病患者葡萄糖在目标范围内时间与射血分数保留的心力衰竭的相关性[J]. 中华实用诊断与治疗杂志,2023,37(6):570-575. WANG D Y, DENG X R, SHI X Y, et al. Association between time in range of glucose and heart failure with preserved ejection fraction in patients with type 2 diabetes[J]. Journal of Chinese Practical Diagnosis and Therapy, 2023, 37(6): 570-575.
[17] 金玉琴, 沈菁, 吴秀萍, 等. 胱抑素C, 糖化血红蛋白及尿微量白蛋白与2 型糖尿病血管并发症关系的探讨[J]. 徐州医科大学学报,2020,40(5):370-372. JIN Y Q, SHEN J, WU X P, et al. The relationship between cystatin C,glycosylated hemoglobin and urinary microalbumin and vascular complications in type 2 diabetes[J]. Journal of Xuzhou Medical University, 2020, 40(5): 370-372.
[18] MITA T, KATAKAMI N, OKADA Y, et al. Continuous glucose monitoring-derived time in range and CV are associated with altered tissue characteristics of the carotid artery wall in people with type 2 diabetes[J]. Diabetologia, 2023, 66(12): 2356-2367.
[19] 王臣廷, 安向莲, 吕翠君, 等.2 型糖尿病病人并发大血管病变的危险因素分析[J]. 中西医结合心脑血管病杂志,2023,21(19):3607-3609. WANG C T, AN X L, L? C J, et al. Analysis of risk factors of type 2 diabetes patients complicated with macroangiopathy[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2023, 21(19): 3607-3609.
[20] 许华英, 伊拉代姆·祖冬, 金燕, 等. 脂蛋白(a) 与2型糖尿病大血管病变的相关性[J]. 临床检验杂志,2023,41(6):436-440. XU H Y, IRADAIM Z，JIN Y, et al. Correlation between lipoprotein(a) and macroangiopathy in type 2 diabetes[J]. Chinese Journal of Clinical Laboratory Science, 2023, 41(6): 436-440.
[21] 张蕊, 秦诗阳, 何建秋, 等. 脂联素、直接胆红素及甘油三酯对2 型糖尿病患者大血管病变的诊断价值[J]. 中国现代医学杂志,2023,33(1):13-18. ZHANG R, QIN S Y, HE J Q, et al. Diagnostic value of adiponectin, direct bilirubin, and triglyceride for macro-vascular complications disease in patients with type 2 diabetes[J]. China Journal of Modern Medicine, 2023, 33(1): 13-18.
[22] 孙蔚, 王慧丽, 岳媛媛, 等. 血清炎症因子白细胞介素-18、高敏C 反应蛋白、肿瘤坏死因子-α 与2型糖尿病患者颈动脉粥样硬化的关系[J]. 临床内科杂志,2023,40(4):265-267. SUN W, WANG H L, YUE Y Y , et al. The relationship between serum inflammatory factor interleukin-18,highsensitivity C-reactive protein,tumor necrosis factor alpha and carotid atherosclerosis in patients with type 2 diabetes[J]. Journal of Clinical Internal Medicine, 2023, 40(4): 265-267.

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备注/Memo

备注/Memo:
基金项目：上海市嘉定区卫生健康委员会科研项目（NO：2022-KY-15）。
作者简介：罗云（1982-），女，硕士研究生，副主任医师，研究方向：内分泌与代谢。
更新日期/Last Update: 2025-07-15