2型糖尿病合并冠心病患者血清Hcy、HbAlc和血尿酸水平变化的临床意义

Clinical Significance of Changes of Serum Hcy,HbAlc and Uric Acid Levels in Type 2 Diabetes Patients with Coronary Heart Disease

目的探讨2型糖尿病合并冠心病患者血清同型半胱氨酸(Hcy)、糖化血红蛋白(HbAlc)和血尿酸水平变化的临床意义。方法选取2型糖尿病合并冠心病患者60例为合并冠心病组,单纯2型糖尿病患者45例为单纯糖尿病组,健康志愿者30名为健康对照组。采集空腹外周静脉血,检测血清Hcy、HbAlc及血尿酸水平;行冠状动脉造影检查,记录冠脉狭窄程度50%及以上的病变累及左前降支、回旋支或右冠脉的支数(单支病变、双支病变、多支病变)。收集2型糖尿病合并冠心病患者的年龄、性别、身高、体质量、吸烟情况及低密度脂蛋白、总胆固醇、甘油三酯、空腹血糖、维生素B12、叶酸水平。进行3 a随访,记录患者病情加重再入院、死亡情况。结果合并冠心病组血清Hcy、HbAlc及血尿酸水平明显高于单纯糖尿病组和健康对照组(P<0.05);多支病变患者血清Hcy、HbAlc及血尿酸水平明显高于双支病变和单支病变患者(P<0.05);预后不良组患者血清Hcy、HbAlc及血尿酸水平明显高于预后良好组患者(P<0.05);预后不良组患者中吸烟比例、空腹血糖水平明显高于预后良好组(P<0.05)。Hcy、HbAlc、血尿酸是2型糖尿病合并冠心病患者预后的独立影响因素。ROC曲线分析显示,血清Hcy、HbAlc及血尿酸水平对2型糖尿病合并冠心病患者预后具有较高的预测价值(P<0.05),联合检测的预测价值最高(AUC=0.947)。结论2型糖尿病合并冠心病患者血清Hcy、HbAlc及血尿酸水平升高,且与冠脉病变程度密切相关,联合检测可用于患者预后评估。

Objective To investigate the clinical significance of changes of serum homocysteine(Hcy),glycated hemoglobin(HbAlc)and uric acid levels in patients with type 2 diabetes mellitus(T2DM)combined with coronary heart disease(CHD).Method Sixty patients with T2DM combined with CHD were selected as the combined CHD group,45 patients with T2DM alone were selected as the T2DM group,and 30 healthy volunteers were selected as the healthy control group.Fasting peripheral venous blood samples were collected to detect the serum levels of Hcy,HbAlc and uric acid levels.Coronary angiography was performed to record the number of major coronary arteries(left anterior descending artery,circumflex artery and right coronary artery)with≥50%stenosis.The patients were classified into single-vessel disease,double-vessel disease,and multivessel disease.Age,gender,height,body weight,smoking status,low-density lipoprotein cholesterol,total cholesterol,triglycerides,fasting blood glucose,vitamin B12,and folate levels were collected.A 3-year follow-up was conducted to record hospital re-admissions and mortality.Results The serum levels of Hcy,HbAlc and uric acid in the combined CHD group were significantly higher than those in the T2DM group and the healthy control group(P<0.05).The serum levels of Hcy,HbAlc and uric acid in patients with multivessel disease were significantly higher than those in patients with double-vessel disease and single-vessel disease(P<0.05).The serum levels of Hcy,HbAlc and uric acid in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).The smoking rate and fasting blood glucose level were significantly higher in the poor prognosis group compared to the good prognosis group(P<0.05).Hcy,HbAlc and uric acid were independent factors influencing the prognosis of patients with T2DM combined with CHD.ROC curve analysis showed that serum levels of Hcy,HbAlc and uric acid had high predictive value for the prognosis of patients with T2DM combined with CHD(P<0.05),with the highest predictive value in combination testing(AUC=0.947).Conclusion Serum levels of Hcy,HbAlc and uric acid are increased in patients with T2DM combined with CHD,and are closely related to the severity of coronary artery disease.Combined testing can be used for prognosis evaluation in patients.