急性冠脉综合征患者糖代谢异常的研究

A Study of Abnormal Glucose Metabolism in Patients with Acute Coronary Syndrome

目的:探讨急性冠脉综合征(ACS)患者血糖代谢情况以及糖代谢异常对ACS预后影响的可能机制。方法:检测110例ACS患者的空腹血糖(FBG)、餐后2h血糖(2hPG)、MDA、SOD水平,FBG或2hPG中任一项异常则择期行口服葡萄糖耐量试验(OGTT),根据OGTT结果分为:合并糖尿病组(DM组,36例)、合并糖耐量异常组(IGT组,34例)、40例糖代谢正常患者作为对照组(NGT组)。另入选110例病情稳定的冠心病患者行MDA和SOD的检测。结果:①入院时已确诊糖尿病17例,糖耐量异常3例;入院后经OGTT确诊糖尿病19例,糖耐量异常31例。②合并糖代谢异常的ACS患者MDA显著高于糖代谢正常的ACS患者(P<0.001),SOD水平则显著降低(P<0.001);餐后2h血糖与MDA呈显著正相关。③合并糖尿病和合并糖耐量异常的ACS患者组间MDA、SOD水平比较,差异无显著性意义。结论:在ACS患者中糖代谢异常的发生率高,大部分是入院后经OGTT诊断。同糖尿病患者一样,ACS合并糖耐量异常患者血浆脂质过氧化程度升高,抗氧化能力降低。

Objective： To observe the prevalence of glucose metabolic abnormalities and explore the potential mechanism of the effect of postprandial blood glucose on prognosis in patients with acute coronary syndrome. Methods： According to OGTT,110 patients with acute coronary syndrome were enrolled and divided into three groups, diabetes mellitus group （DM） ,impaired glucose tolerance group（IGT） and normal glucose tolerance group（NGT）. Fasting blood glucose（FBG）, 2 hours postprandial glucose（2 h PG）, malondialdehyde（MDA） and superoxide dismutase（SOD） were measured in all patients, OGTT was performed when FBG or 2hPG was abnormal. Results： Diabetes were diagnosed in 36 patients,34 patients suffered from IGT. There was significant differences in MDA（P〈0.001） and in SOD（P〈0.001） between abnormal glucose metabolism group and NGT group. A remarkably positive correlation existed between 2 h PG and MDA（r = 0.137）. The differences in MDA and in SOD between DM group and IGT group were not signifieant（P〉0.05）. Conclusion： ACS patients are commonly associated with glucose abnormalities. Most of these patients are diagnosed with OGTT after hospitalization. Oxidative stress phenomenon found in ACS patients with DM also exists in ACS patients with IGT, suggesting that both IGT and DM may be risk factors related with cardiovascular events through similar mechanism.