糖化血清蛋白对糖尿病合并急性冠状动脉综合征的诊断意义

The clinical significance of glycosylated serum protein in patients with diabetes complicating acute coronary syndrome

目的观察糖尿病合并急性冠状动脉综合征(ACS)患者中糖化血清蛋白(GSP)水平的变化,探讨GSP对糖尿病合并ACS的诊断意义。方法连续选取海军总医院2008年1-12月收入院的2型糖尿病合并冠心病(CHD)患者共72例,按照合并CHD类型的不同将患者分为:对照组(n=27),合并稳定型心绞痛(SA);观察组(n=45),合并ACS。检测患者的空腹血糖(FPG)、GSP、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平的变化。以GSP=210μmol/L作为分界点,将72例2型糖尿病患者分为暴露组(GSP>210μmol/L,n=40)和非暴露组(GSP≤210μmol/L,n=32),采用ORχ2检验分析两组患者罹患ACS风险的差异。结果两组TC、TG、LDL-C、HbA1c水平无明显差异(P>0.05)。与对照组比较,观察组的FPG、GSP水平明显升高(P<0.05),HDL-C水平明显降低(P<0.05)。暴露组患者GSP水平(275.1±57.9μmol/L)和ACS发生率(75.0%)均明显高于非暴露组(173.3±24.3,46.9%,P<0.05),前者罹患ACS的风险是后者的3.400倍(χ2=6.000,OR=3.400,P=0.014,95%CI:1.254～9.216)。结论2型糖尿病合并ACS患者GSP的升高较HbA1c更加明显,测定GSP可能具有鉴别诊断及进行危险度分层的作用。

Objective To observe the changes in glycosylated serum protein （GSP） level in patients with diabetes complicating acute coronary syndrome （ACS）,and explore the clinical significance of GSP in diagnosing diabetes complicating ACS. Methods Seventy-two patients with type 2 diabetes （T2DM） complicating coronary heart disease （CHD）,admitted from 2008-01-01 to 2008-12-31,were enrolled in the present study. According to the types of CHD,stable angina （SA） and ACS,27 T2DM patients complicated with SA were assigned to the control group and 45 with ACS to the study group. The levels of fasting plasma glucose （FPG）,GSP,hemoglobin A1c （HbA1c）,total cholesterol （TC）,total triglyceride （TG）,high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C） were measured. The 72 patients were subsequently divided into the exposure group （GSP210μmol/L,n=40） and non-exposure group （GSP≤210μmol/L,n=32） according to their GSP levels. An OR χ2 test was applied to analyze the difference in the risk of complicating ACS between the two groups. Results The levels of TC,TG,LDL-C and HbA1c were slightly higher in study group but no statistically significant difference was observed （P0.05）. In comparison with the control group,the levels of FPG and GSP were significantly higher （P0.05）,while HDL-C was lower （P0.05） in study group. Both GSP level and ACS incidence in exposure group （275.055±57.88μmol/L,75.0%） were higher than that in non-exposure group （173.281±24.28,46.9%,P0.05）. The risk of complicating ACS in exposure group was 3.400 fold of that in non-exposure group （χ2=6.000,OR=3.400,P=0.014,95% CI：1.254-9.216）. Conclusions Compared with HbA1c,the elevation of GSP level is more significant in the diagnosis of T2DM patients with ACS. Detection of GSP may be helpful for early diagnosis and risk appraisal.