NIDDM 患者并发冠心病的危险因素分析

Analiss on the risk factors of coronary heart disease in patients with non-insulin-dependent diabetes mellitus

目的初步探讨非胰岛素依赖性糖尿病（ＮＩＤＤＭ）患者并发冠心病的危险因素。方法将６５例ＮＩＤＤＭ患者分为无慢性并发症组和并发冠心病组，每组病人根据糖化血红蛋白水平又分为血糖控制较好组和血糖控制较差组，并设立正常对照组。分析各组病人ＨｂＡ１ｃ、血脂及血胰岛素水平及其与合并冠心病的关系。结果各糖尿病组患者普遍存在着脂代谢紊乱和高胰岛素血症，且以并发冠心病组最为明显。脂代谢紊乱主要表现为血甘油三酯、总胆固醇、低密度脂蛋白胆固醇和载脂蛋白Ｂ１００的升高，高密度脂蛋白胆固醇和载脂蛋白Ａ１的降低。血糖的控制有助于上述有关指标的改善。结论ＮＩＤＤＭ患者普遍存在着脂代谢紊乱和高胰岛素血症，此为ＮＩＤＤＭ患者并发冠心病的危险因素。

Objective To study primarily the risk factors of coronary heart disease (CHD) in patients with non-insulin-dependent diabetes mellitus (NIDDM).Methods Sixty five cases of NIDDM patients were divided into two groups: diabetic group without chronic complications and diabetic group complicated with CHD.According to the levels of glycosylated hemoglobin (HbA1c), the patients in each group were subdivided into two subgroups: plasma glucose controlled well group and plasma glucose controlled badly group. A control group in 32 normal subjects was designed. Serum lipids and fasting serum insulin (FIN) were examined and the relationship between them and CHD was assayed.Results There were general disorders of lipid metabolism and hyperinsulinemia in both groups of the patients with diabetes mellitus, especially in the diabetic group complicated with CHD. The abnormal lipid metabolism showed that the plasma triglyceride, cholesterol, low density lipoprotein-cholesterol and apolipoprotein B100 were higher than those of control group, high density lipoprotein-cholesterol and apolipoprotein A1 were lower than those of control group. The controlling blood plasma glucose could improve the abnormal lipid metabolism and hyperinsulinemia. Conclusion There are general disorders of lipid metabolism and hyperinsulinemia in NIDDM patients, which appears to be risk factors to CHD in NIDDM patients.