糖耐量受损与冠状动脉病变相关性的研究

Relationship of the extent and severity of coronary artery disease with impaired glucose tolerance

目的:探讨糖耐量受损与冠状动脉(冠脉)病变程度的相关性。方法:回顾分析524例拟诊冠心病(CHD)并行冠脉造影患者的临床资料,冠脉造影病变程度以诊断是否CHD、冠脉病变支数和冠脉病变Gensini总积分三方面确定;根据口服葡萄糖耐量试验2 h血浆葡萄糖(2 h PG)水平将所有研究对象分为3组:第1组,2 h PG<7.8 mmol/L;第2组,2 h PG 7.8～11.0 mmol/L;第3组,2 h PG≥11.1 mmol/L。进行组间CHD危险因素和冠脉病变程度比较,对2 h PG水平与冠脉病变程度进行单因素和多因素分析。结果:①随着2 h PG逐渐升高,CHD患病率、冠脉病变积分、多支病变发生率逐渐升高(P<0.05);②2 h PG水平与冠脉病变支数(r=0.346;P<0.05)、冠脉病变Gensini积分(r=0.418;P<0.05)呈正相关;③多元逐步回归分析显示2 h PG水平与冠脉病变支数(β=0.383,P<0.05)、冠脉病变总积分(β=0.304,P<0.05)独立相关;④Logistic回归分析显示2 h PG水平为CHD独立危险因素(OR:2.685;95%CI:1.257～2.869;P<0.01)。结论:糖耐量受损与冠脉粥样硬化密切相关,随着2 h PG水平升高,冠脉病变程度愈严重。

Objective：To evaluate the correlation of impaired glucose tolerance with the extent and severity of coronary artery disease（CAD） in patients who underwent coronary angiography. Method：A total of 524 consecutive patients who underwent coronary angiography were selected in the study.The extent and severity of angiographic CAD were evaluated by： ①whether or not with CAD by diagnosed by angiography;②the number of diseased vessels;③The CAD Gensini cumulative index.According to 2 h plasma glucose（2 h PG） after oral glucose tolerance test（OGTT）,all patients were stratified into three group： group 1： 2 h PG 7.8 mmol/L;group 2： 2 h PG 7.8-11.0 mmol/L;group 3： 2 h PG≥11.1 mmol/L.The CHD risk factors and the lesion degree of coronary arteries were compared among three groups.The relationship of 2 h PG and CAD were analyzed by univariate and multivariate analyses. Result：①The incidence of CHD,the CAD Gensini cumulative index,the incidence of multi-vessel lesions were elevated with the increase of 2 h PG level（P0.05）.②After adjusting other influencing factors,there were significantly positive correlation between the number of diseased vessels,the CAD Gensini cumulative index and 2 h PG（P0.05）.③Mutivariate stepwise regression analysis showed there were independent correlation of 2 h PG with the diseased vessles（β=0.383,P0.05） and CAD Gensini cumulative index（β=0.304,P0.05）.④The Logistic regression analysis showed 2 h PG was the independent risky factor of CH.（OR=2.685,95%CI： 1.257-2.869,P0.01）. Conclusion：The extent and severity of angiographic coronary artery disease have significant correlations with the impaired glucose tolerance,and the extent and severity can increase with the increasing 2 h PG.