2型糖尿病与绝经后女性冠心病患者冠状动脉狭窄程度的相关性分析

Correlation between type 2 diabetes and the degree of coronary artery stenosis in postmenopausal women with coronary artery disease

目的探讨绝经后女性冠心病患者的危险因素以及2型糖尿病与冠状动脉病变严重程度的关系。方法 1615例经冠状动脉造影诊断的绝经后女性冠心病患者,其中合并2型糖尿病者444例(27.5%),未合并2型糖尿病者1171例(72.5%),采用单因素方差分析及多因素回归分析观察2型糖尿病与绝经后女性冠心病患者病变程度的关系。冠状动脉造影病变程度用病变支数及病变Gensini积分表示。结果单因素分析显示,与非糖尿病组相比,糖尿病组绝经后女性冠心病患者的年龄更大(P=0.004),合并高血压、高脂血症、脑血管病、肥胖及慢性肾脏病的比例更高(P<0.05),且收缩压、甘油三酯及空腹血糖水平更高(P<0.05),高密度脂蛋白、血清总胆红素及直接胆红素水平更低(P<0.05)。糖尿病患者的冠状动脉狭窄Gensini积分(41.62±33.30)较非糖尿病患者(31.56±31.32)更高(P<0.001),且病变血管支数较非糖尿病患者更多(P<0.001)。多因素logistic回归分析显示糖尿病病史是3支血管病变的最强独立危险因素(OR=1.837)。结论糖尿病是绝经后女性冠心病患者3支冠状动脉病变最强的危险因素;2型糖尿病可加重绝经后女性冠心病患者冠状动脉病变程度。

Objective To investigate the correlation between type 2 diabetes and the degree of coronary artery stenosis in postmenopausal women with coronary artery disease（CAD）.Methods Out of 1615 postmenopausal women diagnosed as CAD by coronary angiography,444 were also suffering form type 2 diabetes,and the other 1171 were not.CAD severity was assessed by the Gensini score and the number of arteries involved.Correlation between diabetes and the degree of coronary artery lesions in postmenopausal women with CAD were evaluated by both single factor analysis and multivariate binary logistic regression analysis.Results Compared with the non-diabetic group,single factor analysis revealed that the diabetic postmenopausal women were older（P=0.004）,and with higher incidence of hypertension,hyperlipidemia,cerebrovascular disease,obesity and chronic kidney disease,higher levels of systolic blood pressure,triglycerides,fasting plasma glucose,and lower levels of total bilirubin and direct bilirubin（P〈0.05）.There was a higher Gensini score in T2DM patients than in non-diabetic women（41.62±33.30 vs 31.56±31.32,P〈0.001）,and more diseased arteries in the women with diabetes than in the non-diabetic women（P〈0.001）.Logistic regression analysis showed that T2DM was the most significant independent risk factor of 3-vessel disease（OR=1.837）.Conclusions Diabetes is an independent risk factor for 3-vessel disease of postmenopausal women with CAD.The severity of CAD in postmenopausal women is associated with T2DM.