睡眠障碍与2型糖尿病患者血管并发症及治疗效果的相关性研究

发布时间：2018-06-19 13:27

本文选题：2型糖尿病 + 糖尿病血管并发症　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:1、探究睡眠障碍与2型糖尿病血管并发症之间的相关性2、探究糖基化终末产物(AGEs)在睡眠障碍与2型糖尿病心血管疾病发生中的意义及作用3、探究睡眠教育对伴睡眠障碍的2型糖尿病患者血糖控制作用及潜在的机制方法:1、通过收集天津医科大学代谢病医院2013年1月至2016年1月1220例的2型糖尿病住院患者。纳入标准为1999年WHO的2型糖尿病诊断指南。依据患者血管并发症情况分为糖尿病心血管疾病(CVD)、糖尿病肾脏病变(DKD)、糖尿病视网膜血管疾病(DR)、糖尿病外周动脉血管疾病(PAD)和糖尿病周围神经病变(DPN)。将患者的睡眠障碍情况分为入睡困难,觉醒过早,睡眠时间过短(6小时)及睡眠时间过长(9小时)。对所有患者进行了人口统计学资料的收集,并且进行了一系列的物理检查,包括BMI(体重指数)和BP(血压),生化检查指标依据Hb A1c(糖化血红蛋白)。所有的计量资料均以均数±标准差(SD)表示,分类变量资料采用卡方检验来分析,多元回归分析用于分析睡眠障碍与糖尿病血管并发症之间的关系,并采用比值比(OR)和95%的置信区间(CI)进行分析。双边P值0.05被认为有统计学差异。所有数据使用SPSS18.0进行分析。2、通过收集天津医科大学代谢病医院2013年6月至2015年6月的587例2型糖尿病患者,纳入标准为1999年WHO的2型糖尿病诊断指南,心血管疾病诊断依据2014欧洲心脏病学会诊断及治疗指南。并通过匹兹堡睡眠质量指数量表(PSQI)对其睡眠质量进行评估,依据匹兹堡睡眠质量指数量表评分将患者分为睡眠障碍组(PSQI评分≥7,n=241)与非睡眠障碍组(PSQI评分7,n=346)。对所有患者进行了人口统计学资料的收集,并且进行了一系列的物理检查,包括BMI(体重指数)和BP(血压)。生化检查指标依据AGEs(糖基化终末产物)。正态分布的计量资料均以均数±标准差(SD)表示,非正态分布计量资料以M(P 25,P 75)表示,分类变量资料采用卡方检验来分析。采用独立样本t检验和秩和检验比较两组间数据,行Pearson相关或Spearman秩相关进行相关性分析,以及Logistic回归对模型影响因素进行分析。双边P值0.05被认为有统计学差异。所有数据使用SPSS18.0进行分析。3、通过收集天津医科大学代谢病医院2014年2月至8月的30例2型糖尿病患者,将患者随机分为实验组和对照组。患者将接受由受过训练的教育工作者同等时间的结构化糖尿病睡眠教育(实验组)或传统的糖尿病教育,并随访3个月。本研究的主要结果是通过对比实验组和对照组之间在3个月干预前后,匹兹堡睡眠质量指数(PSQI)评分的变化差异,本研究的另一个主要结果是对比3个月干预前后两组之间Hb A1c变化的差异,本研究的次要结果是对比两组干预前后,其BP,BMI,HOMA IR和FPG,瘦素,胃促生长素,hs CRP,IL-6,TNFα,生长激素以及血清皮质醇的浓度变化的差异。采用配对t检验和卡方检验用于分析组间参数变化的差异,采用偏相关和线性回归分析探讨血清相关因素与Hb A1c变化的相关性。双边P值0.05被认为有统计学差异。所有数据使用SPSS18.0进行分析。结果:1、经混杂因素调整后,研究结果显示睡眠时间过短是糖尿病肾脏病变(DKD)(OR1,P0.05)的独立危险因素,睡眠时间过长是糖尿病视网膜血管疾病(DR)(OR1,P0.05)的独立危险因素,觉醒过早和睡眠时间过短是糖尿病心血管疾病(CVD)(OR1,P0.05)的危险因素,睡眠时间过短是糖尿病外周动脉血管疾病(PAD)(OR1,P0.05)的危险因素,睡眠障碍与糖尿病周围神经病变(DPN)(P0.05)之间无相关性;2、与非睡眠障碍组相比,睡眠障碍组心血管疾病比例、AGEs和PSQI评分均高(均P0.05)。PSQI评分与AGEs水平呈正相关(rs=0.548,P0.001),与心血管疾病呈正相关(rs=0.181,P0.05),AGEs水平与心血管疾病呈正相关(rs=0.266,P0.001)。AGEs水平随着PSQI评分升高而升高(β=0.505)。PSQI高评分(OR=1.062,95%CI:1.019-1.119)、AGEs高水平(OR=2.145,95%CI:1.431-3.214)是2型糖尿病患者心血管疾病的危险因素。3、睡眠教育和常规糖尿病教育(8个课程,280分钟)为本研究的主要干预措施。经相关教育后,与对照组患者相比,实验患者的生活方式得到了很大的改善,PSQI得分显著降低(-1.48±0.88vs.-0.51±0.71,P0.001),以及Hb A1c显著降低(-1.5±0.55vs.-1.11±0.47,P0.05)。空腹静脉血糖和收缩压也显著降低。胰岛素抵抗指数显著降低(-1.29±0.97vs.1.04±0.91,P0.01)。超敏C反应蛋白、IL-6、皮质醇和胃促生长素显着降低,瘦素和生长激素无明显改变。偏相关结果表明,Hb A1c的改善与胃促生长素(系数-0.65,P0.001)、皮质醇(系数-0.38,P0.05)和IL-6(系数0.452,P0.05)有关。线性回归分析显示,胃促生长素的变化与Hb A1c的变化呈负相关。结论:1、睡眠障碍对糖尿病患者的血管并发症有一定影响。2、糖尿病心血管疾病的危险因素之一是睡眠障碍,随着睡眠质量的下降,AGEs水平随之升高。因此,AGEs较高的水平是糖尿病心血管疾病患病的危险因素。3、睡眠教育可以改善2型糖尿病患者的睡眠质量,并且有益于患者的血糖及收缩压的控制,并能降低患者胰岛素的抵抗程度,引起糖化血红蛋白降低的原因可能是由于血清胃促生长素分泌的减少导致。
[Abstract]:Objective: 1, explore the correlation between sleep disorders and vascular complications of type 2 diabetes, 2, explore the significance and role of glycosylated end products (AGEs) in the pathogenesis of sleep disorders and type 2 diabetes, 3, explore the effect of sleep education on the control of blood glucose in patients with type 2 diabetes with sleep disorders and potential mechanisms: 1. 1220 hospitalized patients with type 2 diabetes from January 2013 to January 2016, Medical University Of Tianjin, were included in the criteria for the diagnosis of type 2 diabetes in 1999 WHO. According to patients' vascular complications, diabetic cardiovascular disease (CVD), diabetic renal disease (DKD), diabetic retinopathy of vascular disease (DR), diabetes peripheral Arterial disease (PAD) and diabetic peripheral neuropathy (DPN). The patient's sleep disorder is divided into difficulty in sleeping, early awakening, short sleep time (6 hours) and too long sleep time (9 hours). Demographic data are collected in all patients and a series of physical tests, including the BMI (body mass index), are carried out. And BP (blood pressure), the biochemical indexes were based on Hb A1c (glycosylated hemoglobin). All the measurement data were expressed as mean standard deviation (SD). The data of the classified variables were analyzed by chi square test. The multivariate regression analysis was used to analyze the relationship between sleep disorders and diabetic vascular complications, and the ratio Ratio (OR) and 95% confidence interval (CI) were used. Analysis. The bilateral P value 0.05 was considered statistically different. All data were analyzed by SPSS18.0 for.2. 587 patients with type 2 diabetes from June 2013 to June 2015 of Medical University Of Tianjin were collected and included in the diagnostic guide for type 2 diabetes in the 1999 WHO, and the diagnosis of cardiovascular disease was based on 2014 European Cardiology. The quality of sleep was assessed by the Pittsburgh sleep quality index (PSQI) and the Pittsburgh sleep quality index scale (PSQI score > 7, n=241) and non sleep disorder group (PSQI score 7, n= 346). And a series of physical tests were carried out, including BMI (body mass index) and BP (blood pressure). The biochemical indexes were based on AGEs (glycosylation end products). The measurement data of normal distribution were expressed with mean mean standard deviation (SD). The non normal distribution data were expressed in M (P 25, P 75), and the data of classified variables were analyzed by chi square test. Sample t test and rank sum test compared two groups of data, Pearson correlation or Spearman rank correlation analysis, and Logistic regression analysis of the influence factors of the model. Bilateral P value 0.05 was considered statistically significant. All data were analyzed by SPSS18.0 for.3, through the collection of Medical University Of Tianjin metabolic hospital 2 in 2014. From month to August, 30 patients with type 2 diabetes were randomly divided into experimental and control groups. The patients received structured diabetes sleep education (experimental group) or traditional diabetes education at the same time of trained educators and followed up for 3 months. The main results of this study were to be compared between the experimental group and the control group. The difference in the Pittsburgh sleep quality index (PSQI) score before and after 3 months of intervention. The other main result of this study was to compare the changes of Hb A1c between the two groups before and after the intervention of 3 months. The secondary result of this study was to compare the BP, BMI, HOMA IR and FPG, leptin, gastrin, HS CRP, IL-6, TNF alpha, growth hormone before and after the intervention of the two groups. The difference in the change of serum cortisol concentration. Using paired t test and chi square test was used to analyze the difference between the parameters of the group. The correlation of serum related factors and the changes of Hb A1c was analyzed by partial correlation and linear regression analysis. The bilateral P value 0.05 was considered statistically different. The data were analyzed with SPSS18.0. Results: 1, After adjusted by confounding factors, the results show that too short sleep time is an independent risk factor for diabetic renal disease (DKD) (OR1, P0.05). Excessive sleep time is an independent risk factor for diabetic retinopathy of vascular disease (DR) (DR) (OR1, P0.05). The risk of premature awakening and too short sleep time is the risk cause of diabetes (CVD) (OR1, P0.05). The short sleep time was a risk factor for diabetic peripheral arterial disease (PAD) (OR1, P0.05), and there was no correlation between sleep disturbance and diabetic peripheral neuropathy (DPN) (P0.05). 2, compared with the non sleep disorder group, the higher (both P0.05).PSQI score and the AGEs and PSQI scores in the sleep disorder group were positively correlated with the AGEs and PSQI scores. (rs=0.548, P0.001) was positively correlated with cardiovascular disease (rs=0.181, P0.05), AGEs level was positively correlated with cardiovascular disease (rs=0.266, P0.001).AGEs level increased with the increase of PSQI score (beta =0.505).PSQI high score (OR=1.062,95%CI:1.019-1.119), which was the cardiovascular disease of type 2 diabetic patients. Risk factors.3, sleep education and routine diabetes education (8 courses, 280 minutes) were the main intervention measures in this study. After related education, compared with the control group, the life style of the experimental patients was greatly improved, the score of PSQI decreased significantly (-1.48 + 0.88vs.-0.51 + 0.71, P0.001), and the Hb A1c significantly decreased (-1.5 + 0.55vs.-). 1.11 + 0.47, P0.05). The blood glucose and systolic pressure decreased significantly in the fasting vein. The insulin resistance index decreased significantly (-1.29 + 0.97vs.1.04 + 0.91, P0.01). The hypersensitive C reactive protein, IL-6, cortisol and gastro auxin were significantly reduced, and the leptin and growth hormone were not significantly changed. The partial clearance result showed that the improvement of Hb A1c and gastro growth factor (coefficient -0.65) P0.001), cortisol (coefficient -0.38, P0.05) and IL-6 (coefficient 0.452, P0.05). Linear regression analysis showed a negative correlation between the changes of gastro gastrin and the changes of Hb A1c. Conclusion: 1, sleep disorders have a certain influence on the vascular complications of diabetic patients with.2, and one of the risk factors for the cardiovascular disease of diabetic patients is sleep disorder, with sleep. As a result of the decline in quality, the AGEs level increases. Therefore, the higher AGEs level is the risk factor for cardiovascular disease in diabetes.3. Sleep education can improve the quality of sleep in type 2 diabetics and benefit the control of patients' blood glucose and systolic blood pressure, and reduce the degree of insulin resistance in patients and cause glycated hemoglobin. The low level may be due to a decrease in serum ghrelin secretion.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R740

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