發(fā)布時(shí)間：2018-06-19 13:27

  本文選題：2型糖尿病 + 糖尿病血管并發(fā)癥�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1、探究睡眠障礙與2型糖尿病血管并發(fā)癥之間的相關(guān)性2、探究糖基化終末產(chǎn)物(AGEs)在睡眠障礙與2型糖尿病心血管疾病發(fā)生中的意義及作用3、探究睡眠教育對(duì)伴睡眠障礙的2型糖尿病患者血糖控制作用及潛在的機(jī)制方法:1、通過收集天津醫(yī)科大學(xué)代謝病醫(yī)院2013年1月至2016年1月1220例的2型糖尿病住院患者。納入標(biāo)準(zhǔn)為1999年WHO的2型糖尿病診斷指南。依據(jù)患者血管并發(fā)癥情況分為糖尿病心血管疾病(CVD)、糖尿病腎臟病變(DKD)、糖尿病視網(wǎng)膜血管疾病(DR)、糖尿病外周動(dòng)脈血管疾病(PAD)和糖尿病周圍神經(jīng)病變(DPN)。將患者的睡眠障礙情況分為入睡困難,覺醒過早,睡眠時(shí)間過短(6小時(shí))及睡眠時(shí)間過長(9小時(shí))。對(duì)所有患者進(jìn)行了人口統(tǒng)計(jì)學(xué)資料的收集,并且進(jìn)行了一系列的物理檢查,包括BMI(體重指數(shù))和BP(血壓),生化檢查指標(biāo)依據(jù)Hb A1c(糖化血紅蛋白)。所有的計(jì)量資料均以均數(shù)±標(biāo)準(zhǔn)差(SD)表示,分類變量資料采用卡方檢驗(yàn)來分析,多元回歸分析用于分析睡眠障礙與糖尿病血管并發(fā)癥之間的關(guān)系,并采用比值比(OR)和95%的置信區(qū)間(CI)進(jìn)行分析。雙邊P值0.05被認(rèn)為有統(tǒng)計(jì)學(xué)差異。所有數(shù)據(jù)使用SPSS18.0進(jìn)行分析。2、通過收集天津醫(yī)科大學(xué)代謝病醫(yī)院2013年6月至2015年6月的587例2型糖尿病患者,納入標(biāo)準(zhǔn)為1999年WHO的2型糖尿病診斷指南,心血管疾病診斷依據(jù)2014歐洲心臟病學(xué)會(huì)診斷及治療指南。并通過匹茲堡睡眠質(zhì)量指數(shù)量表(PSQI)對(duì)其睡眠質(zhì)量進(jìn)行評(píng)估,依據(jù)匹茲堡睡眠質(zhì)量指數(shù)量表評(píng)分將患者分為睡眠障礙組(PSQI評(píng)分≥7,n=241)與非睡眠障礙組(PSQI評(píng)分7,n=346)。對(duì)所有患者進(jìn)行了人口統(tǒng)計(jì)學(xué)資料的收集,并且進(jìn)行了一系列的物理檢查,包括BMI(體重指數(shù))和BP(血壓)。生化檢查指標(biāo)依據(jù)AGEs(糖基化終末產(chǎn)物)。正態(tài)分布的計(jì)量資料均以均數(shù)±標(biāo)準(zhǔn)差(SD)表示,非正態(tài)分布計(jì)量資料以M(P 25,P 75)表示,分類變量資料采用卡方檢驗(yàn)來分析。采用獨(dú)立樣本t檢驗(yàn)和秩和檢驗(yàn)比較兩組間數(shù)據(jù),行Pearson相關(guān)或Spearman秩相關(guān)進(jìn)行相關(guān)性分析,以及Logistic回歸對(duì)模型影響因素進(jìn)行分析。雙邊P值0.05被認(rèn)為有統(tǒng)計(jì)學(xué)差異。所有數(shù)據(jù)使用SPSS18.0進(jìn)行分析。3、通過收集天津醫(yī)科大學(xué)代謝病醫(yī)院2014年2月至8月的30例2型糖尿病患者,將患者隨機(jī)分為實(shí)驗(yàn)組和對(duì)照組。患者將接受由受過訓(xùn)練的教育工作者同等時(shí)間的結(jié)構(gòu)化糖尿病睡眠教育(實(shí)驗(yàn)組)或傳統(tǒng)的糖尿病教育,并隨訪3個(gè)月。本研究的主要結(jié)果是通過對(duì)比實(shí)驗(yàn)組和對(duì)照組之間在3個(gè)月干預(yù)前后,匹茲堡睡眠質(zhì)量指數(shù)(PSQI)評(píng)分的變化差異,本研究的另一個(gè)主要結(jié)果是對(duì)比3個(gè)月干預(yù)前后兩組之間Hb A1c變化的差異,本研究的次要結(jié)果是對(duì)比兩組干預(yù)前后,其BP,BMI,HOMA IR和FPG,瘦素,胃促生長素,hs CRP,IL-6,TNFα,生長激素以及血清皮質(zhì)醇的濃度變化的差異。采用配對(duì)t檢驗(yàn)和卡方檢驗(yàn)用于分析組間參數(shù)變化的差異,采用偏相關(guān)和線性回歸分析探討血清相關(guān)因素與Hb A1c變化的相關(guān)性。雙邊P值0.05被認(rèn)為有統(tǒng)計(jì)學(xué)差異。所有數(shù)據(jù)使用SPSS18.0進(jìn)行分析。結(jié)果:1、經(jīng)混雜因素調(diào)整后,研究結(jié)果顯示睡眠時(shí)間過短是糖尿病腎臟病變(DKD)(OR1,P0.05)的獨(dú)立危險(xiǎn)因素,睡眠時(shí)間過長是糖尿病視網(wǎng)膜血管疾病(DR)(OR1,P0.05)的獨(dú)立危險(xiǎn)因素,覺醒過早和睡眠時(shí)間過短是糖尿病心血管疾病(CVD)(OR1,P0.05)的危險(xiǎn)因素,睡眠時(shí)間過短是糖尿病外周動(dòng)脈血管疾病(PAD)(OR1,P0.05)的危險(xiǎn)因素,睡眠障礙與糖尿病周圍神經(jīng)病變(DPN)(P0.05)之間無相關(guān)性;2、與非睡眠障礙組相比,睡眠障礙組心血管疾病比例、AGEs和PSQI評(píng)分均高(均P0.05)。PSQI評(píng)分與AGEs水平呈正相關(guān)(rs=0.548,P0.001),與心血管疾病呈正相關(guān)(rs=0.181,P0.05),AGEs水平與心血管疾病呈正相關(guān)(rs=0.266,P0.001)。AGEs水平隨著PSQI評(píng)分升高而升高(β=0.505)。PSQI高評(píng)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險(xiǎn)因素。3、睡眠教育和常規(guī)糖尿病教育(8個(gè)課程,280分鐘)為本研究的主要干預(yù)措施。經(jīng)相關(guān)教育后,與對(duì)照組患者相比,實(shí)驗(yàn)患者的生活方式得到了很大的改善,PSQI得分顯著降低(-1.48±0.88vs.-0.51±0.71,P0.001),以及Hb A1c顯著降低(-1.5±0.55vs.-1.11±0.47,P0.05)�？崭轨o脈血糖和收縮壓也顯著降低。胰島素抵抗指數(shù)顯著降低(-1.29±0.97vs.1.04±0.91,P0.01)。超敏C反應(yīng)蛋白、IL-6、皮質(zhì)醇和胃促生長素顯著降低,瘦素和生長激素?zé)o明顯改變。偏相關(guān)結(jié)果表明,Hb A1c的改善與胃促生長素(系數(shù)-0.65,P0.001)、皮質(zhì)醇(系數(shù)-0.38,P0.05)和IL-6(系數(shù)0.452,P0.05)有關(guān)。線性回歸分析顯示,胃促生長素的變化與Hb A1c的變化呈負(fù)相關(guān)。結(jié)論:1、睡眠障礙對(duì)糖尿病患者的血管并發(fā)癥有一定影響。2、糖尿病心血管疾病的危險(xiǎn)因素之一是睡眠障礙,隨著睡眠質(zhì)量的下降,AGEs水平隨之升高。因此,AGEs較高的水平是糖尿病心血管疾病患病的危險(xiǎn)因素。3、睡眠教育可以改善2型糖尿病患者的睡眠質(zhì)量,并且有益于患者的血糖及收縮壓的控制,并能降低患者胰島素的抵抗程度,引起糖化血紅蛋白降低的原因可能是由于血清胃促生長素分泌的減少導(dǎo)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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R740

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 Shalini Singh;Kauser Usman;Monisha Banerjee;;Pharmacogenetic studies update in type 2 diabetes mellitus[J];World Journal of Diabetes;2016年15期

2 Srikant Nannapaneni;Kannan Ramar;Salim Surani;;Effect of obstructive sleep apnea on type 2 diabetes mellitus:A comprehensive literature review[J];World Journal of Diabetes;2013年06期

3 Zeinab Hegab;Stephen Gibbons;Ludwig Neyses;Mamas A Mamas;;Role of advanced glycation end products in cardiovascular disease[J];World Journal of Cardiology;2012年04期

4 馬冠生;崔朝輝;胡小琪;李艷平;劉愛玲;欒德春;孔靈芝;楊曉光;;中國居民的睡眠時(shí)間分析[J];中國慢性病預(yù)防與控制;2006年02期

相關(guān)碩士學(xué)位論文 前1條

1 劉芳;住院2型糖尿病患者睡眠質(zhì)量與血糖及并發(fā)癥的關(guān)系[D];天津醫(yī)科大學(xué);2014年

，

本文編號(hào)：2040040