冠心病合并2型糖尿病患者的临床及冠状动脉造影特点

Clinical Characteristics and Coronary Angiographic Findings in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus

【目的】探讨冠心病合并2型糖尿病患者的临床特征和冠状动脉造影特点。【方法】选择经冠状动脉造影证实的冠心病患者共215例,分为冠心病合并2型糖尿病组(74例,64.7岁±8.2岁)和冠心病非糖尿病组(141例,66.2岁±69.2岁),对比分析两组患者的临床和冠状动脉造影资料。【结果】与冠心病非糖尿病患者比较,冠心病合并2型糖尿病患者更常发生急性心肌梗死、无痛性心肌缺血以及严重心律失常(P<0.01,P<0.05),血中甘油三酯、载脂蛋白B、血尿酸增高(P<0.01,P<0.05),左室舒张末期内径增大(P<0.01),左室射血分数降低(P<0.001)。冠心病合并2型糖尿病患者较多发生3支血管病变(P<0.01),冠状动脉病变多为严重狭窄、完全闭塞以及弥漫性病变(P<0.001)。【结论】冠心病合并2型糖尿病患者临床表现较严重,常有左心功能异常,冠状动脉病变复杂且严重,累及范围广,预后不良。

Objective]To study clinical and coronary angiographic findings in patients with coronary artery diseases (CHD) and type 2 diabetes mellitus. [Methods]A total of 215 patients with CHD confirmed by coronary angiography were involved in this study. The patients were divided into two groups: 74 CHD patients with type 2 diabetes mellitus (mean age 64.7±8.2 years, male/female 47/27), and 141 CHD patients without type 2 diabetes mellitus (mean age 66.2±9.2 years, male/female 100/41). The clinical features and the data from selective coronary angiographies were compared between type 2 diabetic and non diabetic CHD patients. [Results] Compared to non diabetic CHD patients, the patients with both CHD and type 2 diabetes mellitus suffered more from acute myocardial infarction, silent ischemia and severe arrhythmias (P < 0.01, P < 0.05), had higher serum triglycerides and apolipoprotein B, along with increased serum uric acid (P < 0.01, P < 0.05), increased left ventricular end diastolic diameter (P < 0.01), and decreased left ventricular ejection fraction (P < 0.001). Compared to non diabetic CHD patients, the patients with both CHD and type 2 diabetes mellitus suffered more from triple vessel disease (P < 0.01), severe coronary arteries stenosis, complete occlusions and diffuse lesions (P < 0.001). [Conclusion]Severe clinical manifestation, left ventricular dysfunction, diffuse or complicated lesions of coronary arteries were more common in patients with both CHD and type 2 diabetes mellitus, that suggested type 2 diabetic CHD patients had poor prognosis.