冠心病合并2型糖尿病患者生化指标与冠脉病变特点分析

Analysis for the characteristics of coronary artery pathological changes and biochemical parameters in patients with coronary heart disease complicated with type 2 diabetes mellitus

目的探讨冠心病(CHD)合并2型糖尿病(2-DM)患者生化指标异常与冠脉损伤的特点,并分析其相关性。方法对已行冠状动脉造影(CAG)的214例患者,根据CAG分析及1997年美国糖尿病学会糖尿病诊断标准分为冠脉正常组(NCHD组)20例,单纯冠心病组(CHD组)138例,冠心病合并2-DM(2-DM组)56例。所有研究对象均进行血糖、血脂、C反应蛋白(CRP)、纤维蛋白原(Fib)检测。冠脉病变程度应用CAG分析,冠脉狭窄程度根据美国心脏病学会分类标准评价。结果(1)与CHD组比较,2-DM组多支病变、C型病变及末梢病变发生率明显增高,冠脉狭窄及钙化程度严重。(2)与NCHD组比较,CHD患者CRP、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、Fib显著增高,高密度脂蛋白胆固醇(HDL-C)显著降低(P<0.01);与CHD组比较,2-DM组CRP、TG、LDL-C、Fib显著增高,HDL-C显著降低(P<0.01),而TC差异无显著意义(P>0.05)。结论CHD合并2-DM患者,冠脉多支病变及C型病变发生率高,狭窄程度及钙化程度严重,末梢病变多见;CRP、TG、LDL-C、Fib、BS为2-DM患者冠脉损伤加重的危险因素。

Objective To analyze the characteristics of coronary artery pathological changes and biochemical parameters in patients with coronary heart disease complicated with type 2 diabetes mellitus （2-DM）.Methods According to the diagnostic standard for diabetes mellitus made by American Diabetes Assoeiations in 1997 and the analysis of coronary artery angiography （CAG）,214 patients examined by CAG were divided into 3 group： normal coronary artery group （NCHD） 20 cases; coronary heart disease group （CHD） 138 cases; coronary heart disease complicated with 2-DM group （2-DM） 56 cases. The blood glucose, blood fat, CRP and fibrinogen（Fib） in all patients were detected. Results （ 1 ） The coronary muhivessel and type C changes and the severity of coronary astery, stenosis and calcification in 2-DM group were significantly higher than those in CHD group. （2） CRP, TG, TC, LDL-C and Fib in CHD group were significantly higher than those in NCHD group, however, HDL-C was obviouslv lower （ P 〈 0.01 ） ：CRP, TG, LDL-C and Fib in 2-DM group were significantly higher than those in CHD group and the HDL-C was obviously lower （ P 〈0.01）,there was no significant difference in TC （ P 〉0.05）.Conclusion In patient with CHD complicated with 2-DM, the incidence of coronary artery changes of muhivessel and type C is high, with severity of comnary artery stenosis anti calcification, and distal coronary and diffusing stenosis are more frequent. CRP, TG, LDL-C and Fib are the risk factors for coronary artery disease in patient with 2-DM.