老年冠心病合并糖尿病的冠状动脉病变特点

Analysis of coronary angiographic characteristics in elderly patients with coronary artery disease plus type 2 diabetes

目的探讨老年冠心病(CAD)合并2型糖尿病(DM)患者冠状动脉病变特点。方法对198例老年CAD合并DM患者(DM组)和387例老年CAD非合并DM患者(NDM组)的临床资料及冠脉造影结果进行统计分析,分别记录各组的冠脉病变特点。结果 2组间年龄、体质量指数(BMI)、吸烟史、高血压史、低密度脂蛋白胆固醇(LDL-C)、血肌酐(Cr)及CAD家族史差异均无统计学意义(P>0.05);DM组糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、三酰甘油(TG)及C反应蛋白(CRP)明显高于NDM组(P<0.05);2组间的左主干(LM)病变、单支病变、双支病变情况差异无统计学意义(P>0.05);但是DM组三支病变的发生率与NDM组比较差异显著(P<0.05),平均置入支架数比较差异极显著(P<0.01);FINS、CRP及HbA1c是多支冠状动脉病变的独立危险因子。结论 2型DM合并CAD患者病变累及冠状动脉数目较多,血管病变弥漫。

Objective To investigate the coronary angiographic characteristics of elderly patients suffering from coronary artery disease（CAD） with type 2 diabetes mellitus（DM）. Methods All patients were divided into two groups. DM group included 198 elderly patients suffering from DM combined with CAD,NDM group included 387 elderly CAD patients without DM. The clinical data and the results of coronary artery angiography were analyzed. Results There were no statistical significance in age,BMI,smoking age,history of high blood pressure,LDL,blood Cr and family history of CAD between the two groups （P〉0.05）; There were statistical significance in HbA1c,FINS,TG and CRP （P〈0.05）;The incidences of LM,single and double vessel lesions were not significantly higher than those in NDM group （9% vs 5 %,15 % vs 19 %,21% vs 18 %,P〉0. 05）; Three vessel diseases and diffuse lesion were more prevalent than those in NDM group （43% vs 19%,P〈0. 05; 38 % vs 21 %,P〈0. 01）. More stents were placed in DM group（2.09±0.21 vs 1.67±0.16,P〈0.01）; FINS,CRP and HbA1c were significantly independent risk factors of diffuse vessel lesions. Conclusions Elderly coronary disease patients with DM show more pathological changes and diffuse lesion in coronary artery.