老年2型糖尿病患者急性心肌梗死早期血糖变异对冠状动脉病变的影响

Relationship of glycemic fluctuations to coronary atherosclerosis in elderly type 2 diabetic patients hospitalized for acute myocardial infarction

目的探讨老年2型糖尿病患者急性心肌梗死(acute myocardial infarction,AMI)早期不同糖代谢状态对冠状动脉病变的影响。方法采用连续血糖监测系统(continuous glucose monitoring system,CGMS)连续跟踪88例老年2型糖尿病AMI患者入院后72 h血糖波动情况,比较不同糖代谢状态患者冠状动脉损害严重程度的差异。结果所有患者依动态血糖监测结果分为:血糖波动正常组(NGF)18例(20.4%);轻微血糖波动组(MGF)30例(34.1%);严重血糖波动组(SGF)40例(45.5%)。和NGF组及MGF组比较,SGF组患者三支血管病变比例显著升高(P<0.01)、单支血管病变比例显著降低(P<0.01);Gensini积分在Q1及Q2比例显著降低(P<0.01),Q3及Q4比例显著升高(P<0.01)。结论老年2型糖尿病患者AMI早期严重血糖波动患者,冠脉病变的程度明显加重,表现为病变血管增多且程度较重。

Objective To explore the relationship between blood glucose fluctuations and coronary atherosclerosis in elderly patients with type 2 diabetes mellitus during early phase of acute myocardial infarction(AMI).Methods 88 diabetic patients hospitalized for AMI underwent continuous glucose monitoring via CGMS.Extent of coronary atherosclerosis of patients with different severity of glycemic fluctuations were evaluated by selective coronary angiography.Results All patients were divided into three groups according to MAGE:18 patient(20.4%) with normal glycemic fluctuations,30 patients(34.1%) with mild glycemic fluctuations and 40 patients(45.5%) with severe glycemic fluctuations.Compared to patients with normal and mild glycemic fluctuations,patients with normal glycemic fluctuations were more likely to have triple-vessel involvement(P<0.01),less likely to have single-vessel disease decrease(P<0.01),lower rate of Q1 and Q2(P<0.01) and higher rate of Q3 and Q4(P<0.01) in Gensini score.Conclusion Elderly type 2 diabetic patients with severe glycemic fluctuations during early phase of AMI are associated with more intensive coronary artery lesions taking form of diffuse and multi-vessele involvement.