中国住院冠心病患者糖代谢异常研究——中国心脏调查

Cross-sectional study on the prevalence of abnormal glucose metabolism in patients with coronary artery disease in China——China Heart Survery

目的探讨中国冠心病患者糖代谢异常的流行状况。方法选取北京、上海等7个城市共52家三级甲等医院为合作研究中心,于2005年6月1日至2005年9月31日在各医院心内科所有符合冠心病诊断纳入标准的住院患者连续入选为研究对象,共收集有效病例3513例。未确诊为糖尿病的对象均需进行口服葡萄糖耐量试验(OGTT),以判断糖代谢状况。结果冠心病住院患者中糖尿病患病率为52.9%,糖调节受损患病率为24.0%,总的糖代谢异常患病率为76.9%。若不进行OGTT试验,仅依靠检测空腹血糖,将有87.4%糖调节异常患者和80.5%糖尿病患者被漏诊。结论中国冠心病住院患者中绝大多数合并糖代谢异常,并且需要通过OGTT及时准确地发现这些合并糖代谢异常的患者。

Objective To investigate the glucometabolic profile of patients with coronary artery disease （CAD） in China. Methods Fifty two hospitals in 7 cities in China paticipated in the survey. All inpatients with CAD in cardiology department of each hospital were consecutively recruited from Jun 1,2005 to Sep 31,2005. A total of 3 513 patients with CAD were included in the study. Patients with previously known diabetes mellitus （DM） （1 153 patients） and newly diagnosed DM （97 patients） were not asked to perform oral glucose tolerance test （OGTY）. The others would perform OGTT to characterize the glucose metabolism status. Results The prevalences of patients with DM and impaired glucose regulation were 52.9% and 24.0% in inpatient with CAD, respectively. The total prevalence of abnormal glucose metabolism was 76.9%. Without the use of OGTT, a majority of patients with abnormal glucose metabolism would have remained undiaguosed in the energency admission group （437 out of 517, 84.5% ） and the scheduled admission groups （791 out of 936, 84.5% ） respectively. In total, 87.4% （738/844） impaired glucose regulation and 80.5% （490/609） DM would remain undiagnosed by fasting plasma glucose （FPG） detection alone. Conclusion The frequency of disturbed glucose metabolism is considerably high in inpatients with CAD. The prevalence of abnormal glucose metabolism would be obviously underestimated by measuring FPG only. OGTT easily discloses the glucometabolic status and should be as a routine procedure in the diagnosis of such patients.