冠心病并发糖调节受损患者的冠状动脉病变分析

Relationship between impaired glucose regulation (IGR) and coronary artery lesion in patients with coronary artery disease

目的探讨冠心病并发糖调节受损患者的冠状动脉病变特点。方法回顾分析2000—2007年冠状动脉造影阳性患者720例,分为糖尿病组(208例)、糖耐量减低组(96例)、空腹血糖受损组(30例)和非糖代谢异常组(386例)。所有患者均测定空腹血糖、空腹胰岛素、餐后2h血糖、血胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白、C反应蛋白、糖化血红蛋白,观察其年龄、冠心病危险因素(包括高血压、高胆固醇血症、体重指数和吸烟)和冠状动脉病变情况。结果 (1)4组在年龄、性别、危险因素等方面差异无统计学意义(P>0.05)。(2)平均弥漫病变血管支数分别为1.53、1.37、1.46高于非糖代谢异常冠心病组0.62(P<0.01)。(3)Logistic回归分析表明空腹胰岛素、C反应蛋白及糖化血红蛋白是弥漫冠脉病变的独立危险因子。结论糖调节受损时冠状动脉已发生严重病变,病变呈弥漫性,与糖尿病组相近。应用口服葡萄糖耐量试验试验及时发现糖代谢异常患者非常重要。

Objective To study the angiographic Characteristics of coronary lesions in patients with coronary disease and impaired glucose regulation（IGR）.Methods To analyse the angiographic characteristics of the coroney lesions of 334 IGR patiens（including 208 T2DM,96 IGT and 30 IFG）with CAD and compared with 386 non-diabetic CAD patients,who underwent coronary angiography between 2000 and 2007.Fasting blood glucose（FBG）,fasting insulin（FINS）,postprandial 2 hours blood glucose（P2hBG）,cholesterol（CHO）,triglyceride（TG）,low density lipoprotein cholesterol（LDL）,high density lipoprotein cholesterol（HDL）and C-Reactive Protein（CRP）and glyceamichaemoglobin（HbA）were measured.Age,risk factors of coronary heart disease（including hypertension,hypercholesteremia and smoking）and coronary artery lesions were recorded at the same time.Results（1）The were no significant differences in age,sex and other CAD risk factors among the four groups（P 0.05）.（2）There are significant difference in the number of diffuse lesion vessels between different IGR groups and non-diabetic CAD patients（1.53,1.37,1.46 vs 0.62）（P 0.01）.（3）By means of logistic regression analysis,FINS,CRP,HbA and LDL were found to be the independent risk factors of diffuse vascular lesion.Conclusion IGR,similar to T2DM,can cause diffuse vessel lesions.OGTT test is important in the early diagnosis of patients with abnormal glucose metabolism.