不同糖代谢状态与冠心病严重程度及C反应蛋白和颈动脉硬化的关系

Relation between C-reactive protein level and carotid intimae-media thickness in patients with coronary artery disease and glucose metabolism

目的探讨不同糖代谢状态与冠状动脉粥样硬化性心脏病（冠心病）严重程度及血清C反应蛋白（hs-caP）和颈动脉硬化的关系。方法选取2008年4月至2010年1月我院心内科冠状动脉造影证实的连续冠心病患者148例，按血糖情况分为糖代谢正常（NGT）组（57例）、糖调节受损（IGR）组（38例）和糖尿病组（53例）。并检测各组患者高敏c反应蛋白（hs-CRP）、血脂、空腹血糖等生化指标，采用超声测定颈动脉内中膜厚度（IMT）。结果IGR组、糖尿病组多支病变例数多，单支病变例数少，冠状动脉造影评分高（分别为27．5±12．6、33．8±11．2），冠状动脉病变程度重，且糖尿病组重于IGR组，差异有统计学意义（P〈0．01）。IGR组、糖尿病组斑块检出率及IMT[分别为73．6％、（1．2±0．2）mm和86．7％、（1．4±0．1）mm]，均明显高于NGT组[56．2％、（1．0±0．2）mm]，且糖尿病组重于IGR组，差异具有统计学意义（P〈0．05）。3组hs-CRP分别为（42．0±58．5）mg／L、（74．3±86．2）mg／L、（116．5±115．6）mg／L，各组间差异具有统计学意义（P〈0．01）。IMT与hs．CRP水平之间呈正相关（r=0．308，P〈0．05）。结论冠心病糖代谢异常患者冠状动脉多支病变多见，病变程度严重，hs-CRP水平、颈动脉IMT值及斑块检出率均高于单纯冠心病组。hs-Cap与颈动脉硬化程度相关。hs-CRP可预测冠心病的严重程度。

Objective To explore the relation between high sensitive C-reactive protein （hs-CRP） level, and carotid intimae-media thickness in Chinese patients with coronary artery disease （CAD）. Methods One hundred and forty eight patients with eoronary heart diseases（ CHD）, who were Weifang Hanting People＇s Hospital patients from April 2008 to January 2010 met the diagnostic criteria for ischemic heart disease. The participants were divided into 3 groups： normal glucose tolerance （NGT） group, impaired glucose regulation （IGR） group and diabe- tes mellitus （DM） group. The coranory angiographic score and clinical data were recorded, hs-CRP, TC, TG, HDL-C, LDL-C and FPG were detected. Carotid intimat-media thickness were measured by Color Doppler ultra- sonography. Results CHD patients with IGR and T2DM often had there branohes disease. The coronary angio- graphic score and the severity of coronary disease of CHD patients with IGR and T2DM were significantly higher than those of patients without diabetes [ （27.5± 12.6）, （33.8 ±11.2）, P 〈0.01 ]. The carotid IMT and the incidence of carotid plaque were higher in CHD patients with IGR and T2DM [ 73.6% vs 86.7 % vs 56.2%, （ 1.2± 0.2） mm vs （ 1.4 ± 0.1 ）mm vs （ 1.0 ±0.2） mm, P 〈 0.05 ]. The CRP levels in normal glucose tolerance （NGT） group, impaired glucose regulation （IGR） group and diabetes mellitus （DM） group were increased [ （42. 0 ± 58.5 ） mg/L, （74.3 ±86.2）mg/L, （116.5± 115.6）mg/L, P 〈 0.01 ]. The serum hs-CRP level was positively correlated with IMT（ r = 0.308,P 〈0.05）. Conclusion The serum hs-CRP and the carotid IMT might be regard as a predicative marker for the severity of coronary heart disease.