冠心病合并代谢综合征患者的临床特征与冠状动脉病变程度的关系

Clinical characteristics of patients with coronary arte ry disease complicated with metabolic syndrome and their correlation with severi ty of coronary stenosis

目的分析冠心病合并代谢综合征患者的临床特征和冠状动脉病变特点。方法回顾性分析本院175例冠心病患者的临床资料及冠状动脉造影结果,按照ATPⅢ诊断标准分为代谢综合征组和无代谢综合征组,以冠状动脉病变积分评价其病变程度。结果175例中89例(50.9%)合并代谢综合征。代谢综合征组的体重指数、腰围、总胆固醇、甘油三酯、尿酸、空腹血糖、餐后2h血糖、糖化血红蛋白、稳态模型的胰岛素抵抗指数及心肌梗死的发生率均显著高于无代谢综合征组,而高密度脂蛋白胆固醇水平显著低于后者;其冠状动脉多支病变发生率(65.1%比45.4%,P<0.01)及冠状动脉病变总积分均显著高于无代谢综合征组(7.5±3.6比6.4±3.3,P<0.05);代谢综合征组中合并糖尿病患者的冠状动脉病变总积分也高于无糖尿病患者(8.0±3.7比6.3±3.5,P<0.05)。相关分析显示,冠状动脉病变程度与患者的腰围、总胆固醇、甘油三酯、糖化血红蛋白、空腹血糖及餐后2h血糖水平呈明显正相关(P<0.05),与高密度脂蛋白胆固醇呈负相关(P<0.01)。结论冠心病患者中合并代谢综合征较为普遍,且合并代谢综合征患者的冠状动脉病变呈多支性、狭窄程度更高,应进行全面心血管危险因素防治,以改善预后。

Objective To analyze clinic al characteristics of patients with coronary artery disease (CAD) complicated with metabolic syndrome (MS) and severity of stenosis in their coronary arteries Methods A total of 175 cases with CAD were retrospectively studied The patients were divided into groups with and without MS according to ATPⅢ diagnostic criteria, and all of them underwent selective coronary angiogr aphy and their severity of coronary stenosis were evaluated by score Results Eighty-nine of 175 cases (509%)complicated with MS showed higher body mass index (BMI), waist circumference, serum total choles terol (TC), triglyceride (TG), uric acid (UA), fasting blood glucose (FBG),two hours postprandial blood glucose(2 h PBG), glucosylated hemoglobin A1c (HbA1c), insulin resistance with homeostasis model assessment (HOMA-IR) and lower high -density lipoprotein-cholesterol (HDL-C) than those without MS Frequency of occurrence of myocardial infarction was significantly higher in patients with M S than that in those without MS Coronary multivessel changes were more frequen tly seen in patients with MS than in those without MS (651% vs 454%, P < 001) and coronary stenosis score was significantly higher in patients with M S, as compared with those without MS (75±36 vs 63±33, P< 005) Total score of coronary stenosis was significantly higher in patients with bo th MS and diabetes, as compared with those with MS only (80±37 vs 64±3 5,P<005) Correlation between severity of CAD and levels of waist circu mference, TC, TG, HbA1c,FBG and 2 h PBG was found with spearman correlation an alysis, with coefficients of correlation of 021, 017, 023, 031, 022 an d 026, respectively (P<005), and reverse correlation between score of co ronary stenosis and level of HDL-C, with a coefficient of correlation of -121 (P<001)Conclusions MS is commonly complicated in patients with CAD, usually with multivessel changes and more severe stenosis It is necessary to control mutiple cardiovascular risk factors comprehensively i n order to improve the prognosis of CAD