糖耐量减低者的冠状动脉病变特点及相关因素分析

Analysis of the characteristics of coronary pathological changes and its related factors in patients with impaired glucose tolerance

目的研究糖耐量减低（IGT）者的冠状动脉病变特点。方法根据糖耐量（OGTr）结果将疑似缺血性胸痛的住院患者490例分为IGT组（161例）、2型糖尿病（T2DM）组（159例）、糖耐量正常（NGT）组（170例），检测3组血清甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和高敏c反应蛋白（hs—CRP）含量，计算BMI，记录一般临床资料（包括性别、年龄、吸烟史、高血压病史），分析3组的冠状动脉造影（CAG）结果和冠状动脉Gensini评分情况。结果（1）T2DM组、IGT组血清TG[（2．41±1．70）mmol／L和（2．26±1．20）mmol／L]均明显高于NGT组[（1．95±1．14）mmo]／L]，差异有统计学意义（t=0．4610，0．3124，P〈0．01，〈0．05），但IGT组和T2DM组间TG水平比较差异无统计学意义（P〉0．05）；3组间TC、HDL-C、LDL—C差异无统计学意义（P均〉0．05）。（2）T2DM组和IGT组血清hs—CRP[（2．38±1．76）mg／L和（2．33±2．03）mg／L]均明显高于NGT组[（1．54±1．32）mg／L，t=0．8391，0．7815，P均〈0．01]，而T2DM组与IGT组比较差异无统计学意义（P〉0．05）。（3）IGT组和T2DM组的BMI[（25．50±3．04）kg／m^2和（26．09±2．86）kg／m^2]均明显高于NGT组[（24．70±3．27）kg／m^2]，差异均有统计学意义（t：0．8063，1．3947，P〈0．05，〈0．01），但T2DM组与IGT组比较差异无统计学意义（P〉0．05）。（4）单支冠状动脉病变发生率NGT组为44．7％，明显高于IGT组（23．6％）和T2DM组（18．9％）（X^2=16．310，25．116，P均〈0．05），但IGT组和T2DM组间差异无统计学意义（P〉0．05）；T2DM组、IGT组2支血管病变发生率分别为37．1％和39．8％，均明显高于NGT组（23．5％）（X^2=7．200，10．099，P均〈0．05），而IGT组和T2DM组间差异无统计学意义（P〉0．05）；3支冠状动脉病变发生率IGT组和T2DM组分别为33．5％和40．9％，均明显高于NGT组（20．0％）（X^2=7．767，17．028，P均〈0．05），IGT组和T2DM组间差异无统计学意义（P〉0．05）。（5）次全或完全闭塞发生率T2DM组和IGT组分别为22．6％和18．0％，均高于NGT组（7．6％）（X^2=14．573，8．019，P均〈0．05），而IGT组和T2DM组间差异无统计学意义（P〉0．05）；IGT组和T2DM组血管弥漫性病变发生率分别为24．8％和30．8％，均高于NGT组（12．4％）（X^2=8．583，16．724，P均〈0．05），但IGT组和T2DM组间差异无统计学意义（P〉0．05）。（6）Gensini评分IGT组和T2DM组分别为（55．05±22．99）和（56．15±24．87），较NGT组（38．03±17．38）明显升高，其差异有统计学意义（t=17．0142，18．1186，P均〈0．01），IGT组与T2DM组问比较差异无统计学意义（P〉0．05）。结论IGT患者2支及3支冠状动脉病变发生率明显升高，次全或完全闭塞及弥漫性病变发生率也明显高于NGT者，与糖尿病患者冠状动脉病变特点相似，提示IGT与冠状动脉病变严重程度密切相关，临床工作中应高度重视此类患者。

Objective To investigate the characteristics of coronary＇s pathological changes in patients with impaired glucose tolerance. Methods Four-hundred and ninety patients who were suspected with ischemic chest pain were divided into three groups according to their OGT＇F results： （ 1 ） IGT group： n = 161, （2） T2DM group： n = 159, （ 3 ） NGT group： n = 170. Serum levels of triglyceride （ TG）, total cholesterol （ TC ）, high- density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C） and high sensitive C- reactive protein （hs-CRP） were detected, their body mass indexes （BMI）were calculated. General clinical information （including gender, age, history of smoking, history of hypertension） were collected. All the CAG results were analyzed and Gensini scores were assessed as well. Results The TG levels in the T2DM group and IGT group （ [2.41±1.70] mmol/L and [2. 26±1.20] mmoL/L） were significantly higher than that of the NGT group （1.95±1.14） mmoL/L,the differences were significant （t =0. 4610,0. 3124,P 〈0. 01 and 0. 05, respectively）, whereas there was no significant difference between the IGT group and T2DM group （P 〉 0. 05 ） ; No significant difference was found among the three groups about TC, HDL-C, LDL-C levels （ either P 〉 0.05 ） ~ The levels of hs-CRP in T2DM group （ [ 2. 38±1.76 ] mg/L and IGT group [ 2. 33±2.03 ] mg/L） were higher compared with the NGT group （ [ 1.54±1.32 ] mg/L） , the differences were significant （ t = 0. 8391, 0. 7815 ,Ps 〈0. 01 ）,whereas there was no significant difference between the IGT group and T2DM group （P 〉 0.05 ）. BMIs of the IGT group （ [ 25.50 ~ 3.04 ] kg/m2 ） and T2DM group （ [ 26.09±2. 86 ] kg/m2 ） were higher than that of the NGT group （ [ 24.70±3.27 ] kg/m2 ）, the differences were significant （ t = 0. 8063, 1. 3947 ,P 〈0. 05 and 〈 0. 01, respectively）, whereas no significant difference was found between the T2DM group and IGT group （P 〉 0. 05 ）. The incidence of single coronary pathological changes was 44.7% in the NGT group,it was higher than that of the IGT group （23.6%） and T2DM group （ 18.9% ） （X2 = 16. 310,25. 116, Ps 〈 0. 05 ） ,whereas there was no significant difference between the IGT group and T2DM group （ P 〉 0. 05 ） ; The incidences of 2 branches pathological changes in the T2DM group （37. 1% ） and IGT group （39. 8% ） were higher compared with NGT group （23.5%） , the differences were significant （X2 = 7. 200,10. 099 ,Ps 〈 0. 05 ） , whereas there was no significant difference between the IGT group and T2DM group（ P 〉 0. 05 ） ;The incidences of 3 vessels pathological changes in the T2DM group （40.9%） and IGT group （33.5%） were higher than that of the NGT group （20. 0% ）, the differences were significant （ X2 = 7. 767,17.028, Ps 〈 0. 05 ）, there was no significant difference between the IGT group and T2DM group （ P 〉 0. 05 ）. The incidence of subtotal or total occlusion of the T2DM group and IGT group were 22. 6% and 18. 0% respectively ,both were higher than that of the NGT group（7.6% ） （ X2 = 14. 573,8. 019 ,Ps 〈 0. 05 ）, whereas no significant difference was found between the T2DM group and IGT group （ P 〉 0. 05 ）. The incidences of vascular diffusing pathological change in the IGT group （24. 8% ） and T2DM group （ 30. 8% ） were higher compared with the NGT group （ 12. 4% ） （ X2 = 8. 583,16. 724, Ps 〈 0. 05 ）, whereas there was no significant difference between the IGT group and T2DM group （P 〉0. 05）. The Gensini scores in the IGT group （55.05 ~ 22. 99） and T2DM group（56. 15±24. 87） were significnatly higher than that of the NGT group （ 38.03 ~ 17.38 ）, the differences were significant （ （ t = 17. 0142,18.1186,Ps 〈0. 01 ） ,whereas there was no significant difference between the IGT group and T2DM group （P 〉 0. 05 ）. Conclusion The incidences of 2 and 3 vessels pathological changes increase significantly in patients with IGT. Moreover, the incidences of occlusion and diffuse stenosis increase significantly. This is similar to the coronary artery pathological charactersitics in patients with diabetes, which indicates that IGT is closely related to the pathological severity of coronary artery. We should pay much attention to those patients with IGT in the clinical work.