伴有糖代谢紊乱冠心病患者的临床特征

Clinical features in patients with coronary heart disease coexisting with glucose metabolic disorders

为了解冠心病患者伴有或不伴有糖代谢紊乱时临床特点，为此，回顾分析８１０例冠心病患者，其中合并糖尿病占１７．２％，合并应激性高血糖状态占１５．８％。冠心病合并糖尿病患者中伴高血压、脑卒中、高脂血症及阳性家族史率较非糖尿病冠心病患者明显升高，该组患者无胸痛型较多（占４９．２％），病情较重，病死率是非糖尿病冠心病者的２．３６倍，该组病人中近四分之一的糖尿病诊断于冠心病之后，近四分之一是两者同时诊断，无论二者诊断先后，其冠心病的其它危险因素的伴发率、临床特征及病死率无显著差异。这提示糖尿病与冠心病可能为伴发或并发关系，前者是后者的危险因素之一，糖尿病的早期诊治对冠心病的预后非常重要。合并应激性高血糖状态的患者年龄较大，病情较重，病死率高，需予重视。

The aim of this study was to elucidate the clinical characteristics of coronary heart disease(CHD) patients with diabetes mellitus(DM), stress induced hyperglycemia(SHG) but normal glucose level. We analyzed 810 patients with CHD who were hospitalized from January 1992 to June 1994. The patients were divided into three groups: DM group, SHG group, and non DM group. In the 810 cases, 17.2% were associated with DM, and 15.8% with SHG. Among the patients in the DM group, 61.2% had hypertension, 18.7% stroke, and 19.4% family history of DM or CHD, which were significantly higher than those in the non DM group. More patients in the DM group (49.2%) had painless acute myocardial infarction. Mortality rate of the DM group was 2.36 times as that of the non DM group. In about 1/4 of the DM patients, the diagnosis of DM was later than that of CHD, and about 1/4, DM and CHD were diagnosed simultaneously. Prevalence of the other CHD risk factors, their clinical features and mortality rate were similar no matter the diagnosis of DM was made before, after or simultaneously with CHD. The data indicated the close relationship between DM and CHD, and the importance of early diagnosis and treatment of DM for the prognosis of CHD. Patients of the SHG group were older. Mortality rate of the SHG was the highest among the three groups, so the SHG patients should not be ignored.