合并糖代谢异常的急性冠脉综合征患者的冠脉病变特征

The Features of Coronary Artery Lesions in Patients with Acute Coronary Syndrome and Glycometabolic Disturbance

目的分析急性冠脉综合征(ACS)合并糖代谢异常患者的冠脉病变特征。方法155例急性ACS患者分为糖耐量正常(A)组、合并糖耐量异常(B)组、合并糖尿病(C)组,所有病例均行75 g葡萄糖耐量试验,测定血糖(FBG、PBG)、胰岛素(FINS、PINS)、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血脂等指标,95例作了冠状动脉造影。比较3组患者的血糖、胰岛素、糖化血红蛋白、高敏C反应蛋白、血脂及冠脉病变。结果C组、B组与A组的FBG、PBG、FINS、PINS、HbA1c、Hs-CRP、TC、LDL-C、UMALB等生化指标比较,差异有统计学意义(P<0.01或0.05);C组和B组的PINS、TC水平差异无统计学意义(P>0.05);B和C组的冠状动脉造影显示病变更为严重,多支血管病变的发生率明显高于A组,差异均有统计学意义(P<0.01);多支血管病变的发生率在B组和C组间的差异无统计学意义(P>0.05)。结论与糖代谢正常的ACS患者相比,合并糖代谢异常的ACS患者有更高的胰岛素水平和高敏C反应蛋白水平,冠脉病变更为严重。糖耐量异常与患糖尿病的ACS患者的冠脉病变相似。

Objective To investigate the features of coronary artery lesions in patients with acute corenary syndrome and glycometabolic disturbance. Methods The 155 patients with acute coronary syndrome were divided into 3 groups according to the World Health Organization（WHO） standard of diabetes diagnosis： the normal glucose tolerance group （group A,44 cases） ; impaired glucose tolerance group （group B, 60 cases） ; diabetes group（group C ,51 cases）.All cases were checked by the 75g glucose tolerance test and tests of blood glucose, insulin, HbAlc, lipid and hypersensitive C reaction protein（hs-CRP）. Ninety-five patients were checked by coronary angiography（CAG）. Among the three groups statistic comparisons were made on the levels of glucose, insulin, HbAlc, lipid, hs-CRP and coronary artery lesions. Result The levels of PBG, FINS, PINS, HbAlc, Hs-CRP, TC and LDL-C, in both group B and C were higher than those in group A; the levels of TG and PINS were not found significant differences between group B andC.The coronary artery lesions showed by CAG in group B and C were more severe than those in group A,Coronary multivessel changes in group B and C were more frequent than those in group A,but no significant difference between group B and C. Conclusion Compared with the patients with normal glucose tolerance, patients with glycometabolic disturbance have higher levels of insulin, hs- CRP and more severe coronary artery lesions. However, the coronary artery lesions in patients with impaired glucose tolerance are similar to those with Diabetes.