糖尿病合并冠心病与白蛋白尿的相关性研究

Relevance of coronary artery affection and Albuminuria in diabetic patients combined with coronary heart disease

目的探讨2型糖尿病合并冠心病患者冠状动脉病变的特点及尿白蛋白与冠状动脉病变程度的关系。方法随机选取经冠状动脉造影确诊的冠心病患者,其中2型糖尿病合并冠心病患者64例为A组,单纯冠心病患者98例为B组,比较两组患者的临床资料和冠状动脉病变情况。A组患者根据冠脉病变支数分为3个亚组,即1支、2支、3支病变组,比较亚组间的尿白蛋白水平;A组患者以年龄、体质量指数、糖尿病病程、血压、血糖、糖化血红蛋白、血脂、尿白蛋白为自变量,分别以病变数、冠脉狭窄指数为因变量进行多元逐步回归分析。结果A组与B组患者在体质量指数、血糖、甘油三酯、高密度脂蛋白胆固醇、尿白蛋白方面的差异均有统计学意义(P均<0.05);与B组患者比较,A组患者冠脉多支病变发生率、弥漫性病变发生率、病变数、冠脉狭窄指数均较高(P均<0.05);A组各亚组间尿白蛋白的差异有统计学意义(P<0.05),病变数、冠脉狭窄指数与尿白蛋白均呈正相关(r值分别为0.5384、0.5762,P均<0.05)。结论2型糖尿病合并冠心病患者冠状动脉病变累及范围广,病变弥漫且严重;尿白蛋白排泄量增加是2型糖尿病发生冠心病的一个危险因素,可在一定程度上反映冠状动脉病变的程度。

Objective To investigate the features of coronary artery affection and the relationship between coronary artery affection degree and albuminuria in type 2 diabetic patients combined with coronary heart disease （CHD）. Methods CHD patients were proved by coronary arteriongraphy. 64 patients with type 2 diabetes in combination with CHD were enrolled in group A and 98 patients with simple CHD served as group B. Patients of group A were subdivided into 3 groups based on scalar of the stenotic coronary artery, viz 1 ramus, 2 rami and 3 rami affection groups, and urinary albumin level was determined. In group A, age, course of DM, BMI, BP, BS, GHbAlc, blood-fat, UAL serving as iv, and affection sum and stenosis index serving as dv, ran polynary gradual regressive analysis. Results There were statistical differences in BMI, FBS, TG, I-IDL-C, and UAL between group A and B （P 〈 0.05）. Compared with group B, group A had increased IN of poly-coronary artery affection, IN of diffuse affection, affection sum and stenosis index（ P 〈 0.05）. In group A, there were statistical differences in UAL among the 3 subsets （ P 〈 0.05）. Affection sum and stenosis indexes had a positive co-linearity with urinary albumin（ r = 0. 548 3, 0. 576 2, P 〈 0.05）. Conclusion In type 2 diabetic patients in combination with CHD, coronary artery affection is extensive, diffuse and severe. An increase of urinary albumin is a risk factor for type 2 diabetic patients who will get coronary heart disease and can reflex the degree of coronary artery affection to some extent.