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血糖变异性对糖尿病并发症的影响及相关机制

刘静怡¹, 安琪¹, 张斯琦¹, 杨彪², 李雅琼^1,*

¹济宁医学院病理学教研室，济宁 272067；²济宁市第一人民医院皮肤科，济宁 272011

摘要

糖尿病是全球重大公共卫生问题，虽然糖化血红蛋白是目前评估糖尿病患者血糖控制水平的金标准，但其在反映血糖波动[即血糖变异性(glycemic variability, GV)]方面存在明显局限性。越来越多的证据表明，GV与糖尿病并发症进展及患者预后显著相关。随着临床治疗中既要实现糖化血红蛋白达标又要避免低血糖这一理念的普及，GV的临床价值日益凸显。本文系统综述GV的概念内涵，阐释其在糖尿病并发症中的最新研究证据，揭示过度血糖波动引发的生化代谢紊乱与病理生理改变，以期为糖尿病患者的风险预警和早期干预提供理论依据。

关键词： 血糖变异性; 糖尿病; 并发症; 血管损伤

The impact of glycemic variability on diabetic complications and related mechanisms

LIU Jing-Yi¹, AN Qi¹, ZHANG Si-Qi¹, YANG Biao², LI Ya-Qiong^1,*

¹Department of Pathology, Jining Medical University, Jining 272067, China；²Department of Dermatology, Jining No. 1 People's Hospital, Jining 272011, China

Abstract

Diabetes mellitus (DM) is a major global health issue, with glycated hemoglobin levels serving as the gold standard for evaluating glucose level control in DM patients. However, it has limitations in reflecting glucose oscillations (i.e. glycemic variability, GV). Increasing evidence suggests that GV is closely related to the progression of diabetes complications and patient prognosis. As people realize the importance of avoiding hypoglycemia while achieving target glycated hemoglobin levels in treatment, the clinical significance of GV becomes more obvious. This article systematically reviewed the concept and connotation of GV, summarized the latest research on its role in the complications of diabetes, and revealed the biochemical and pathophysiological abnormalities caused by excessive glycemic oscillation, aiming to provide a theoretical basis for the risk warning and early intervention of DM patients.

Key words: glycemic variability; diabetes mellitus; complications; vascular injury

收稿日期：　　录用日期：

通讯作者：李雅琼　　E-mail:

DOI: 10.13294/j.aps.2025.0081

引用本文：

刘静怡, 安琪, 张斯琦, 杨彪, 李雅琼. 血糖变异性对糖尿病并发症的影响及相关机制[J]. 生理学报 2025; 77 (5): 925-938.

LIU Jing-Yi, AN Qi, ZHANG Si-Qi, YANG Biao, LI Ya-Qiong. The impact of glycemic variability on diabetic complications and related mechanisms. Acta Physiol Sin 2025; 77 (5): 925-938 (in Chinese with English abstract).