急性冠状动脉综合征患者口服糖耐量试验检查时机选择

Timing of oral glucose tolerance test in patients with acute coronary syndrome

目的探讨急性冠状动脉综合征（ACS）患者口服糖耐量试验（OGTr）的检查时机与安全性。方法选择2007年1月至2012年1月232例ACS住院患者，于病情稳定后及出院后3个月随访时行OGTr，并注意患者心电图和症状变化。结果病情稳定后于出院前OGTT检查发现血糖正常占40．95％（95／232）、糖尿病25．00％（58／232）、糖耐量减低34．05％（79／232）、空腹血糖受损2．59％（6／232），与出院后3个月[血糖正常占39．91％（89／215），糖尿病22．33％（48／215），糖耐量减低33．95％（73／215），空腹血糖受损2．33％（5／215）]比较差异均无统计学意义（x2值分别为0．051、0．441、0．001、0．032，P均〉0．05），心电图sT段比较差异亦无统计学意义[（-0．12±0．08）mV与（-0．15±0．12）mV，t=0．23，P=0．85）。OGTr检查时不良反应少。结论ACS患者为糖代谢异常的高危人群，病情稳定后行OGTT是安全的，对于ACS患者都应常规行OGTT，及早发现糖代谢异常患者，并进行相应干预及治疗。

Objective To investigate the timing and security of oral glucose tolerance test （OGTT） in patients with acute coronary syndrome （ACS）. Methods Two hundred and thirty-two hospitalized patients with ACS were collected from Jan. 2007 to Jan. 2012. OGTT was undergone in a stable condition at 3 months after being discharged,noting ECG and change of symptoms in patients. Results There was no significant difference in test results of proportions of patients with normal blood sugar [40. 95% （95/232） vs. 39.91% （89/215）, x2 =0. 051 ,P 〉0. 05] ,diabetes [25.00% （58/232） vs. 22. 33% （48/215） ,x2 =0. 032,P 〉0.05 ] ,impaired glucose tolerance [ 34.05% （79/232） vs. 33.95% （ 73/215 ）, x2 = 0. 001, P 〉 0. 05 ], and impaired fasting glucose [2. 59% （6/232） vs. 2. 33% （5/215）, x2 = 0. 441, P 〉 0. 05 ] at 3 months after discharge compared with before discharge when patients were in stable conditions. No significant difference was found on ST segment ECG [ （ -0. 12 ±0. 08） mV vs. （ -0. 15 ±0. 12） mV,t =0. 23 ,P =0. 85]. Adverse symptoms were not found during the OGTT examination. Conclusion Patients with ACS have a high risk of abnormal glucose metabolism. Undergoing OGTT is safe for stable status patients with ACS. OGTT should be conducted as the routine exam. Early detection and appropriate intervention and treatment are necessary for patients with abnormal glucose metabolism.