糖化血红蛋白水平与青年男性急性心肌梗死冠状动脉病变程度的相关性研究

Correlation between Glycosylated Hemoglobin A1c and Severity of Coronary Artery Lesions in Young Men with Acute Myocardial Infarction

目的探讨青年男性急性心肌梗死(心梗)患者糖化血红蛋白与冠状动脉病变程度的关系。方法回顾性分析2009年1月至2011年12月在首都医科大学附属北京安贞医院住院诊断为急性心梗并行冠状动脉造影手术的青年男性(年龄≤44岁)共278例,根据冠脉造影结果,分为单支病变组(156例)、双支病变组(64例)和三支病变组(58例),观察糖化血红蛋白(HbA1c)、收缩压、舒张压、血红蛋白(Hb)、血清尿酸(UA)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、体质指数(BMI)、吸烟史、饮酒史及早发冠心病家族史与冠脉病变程度的关系。结果①3组HbA1c水平均逐渐升高,且单支病变组(6.39±1.67%)与双支(6.91±1.63%)和三支病变组(7.41±2.12%)差异有统计学意义(P<0.05);在急性ST段抬高心梗组和非ST段抬高心梗组中,单支病变与三支病变的HbA1c水平差异均有统计学意义(分别为6.42±1.68%vs.7.17±1.86%,P<0.05;5.57±0.37%vs.8.56±2.83%,P<0.05);在糖尿病组和非糖尿病组中,单支病变与三支病变的HbA1c水平差异也均有统计学意义(分别为8.31±1.83%vs.8.59±2.02%,P<0.05;5.56±0.33%vs.5.74±0.37%,P<0.05)。②单支病变组收缩压、TC、HDL-C、LDL-C及饮酒史与其他两组比较差异有统计学意义(P均<0.05);单支病变组与双支病变组舒张压和TG比较差异有统计学意义(P均<0.05)。③logistic回归分析显示,在青年男性急性心梗人群中,LDL-C(OR=1.790)、HbA1c(OR=1.287)及收缩压(OR=1.042)是冠脉多支病变的独立危险因素(P均<0.05)。结论 HbA1c是青年男性急性心梗患者冠脉多支病变的独立危险因素。

Objective To investigate the correlation between glycosylated hemoglobin Alc （HbAlc） and severity of coronary artery lesions in young men with acute myocardial infarction （AM/）. Methods Total 278 young men with AMI less than 45 years old were retrospectively studied, and all of them were admitted to hospital from January 2009 to December 2011, and had undergone coronary angiography. According to the results of coronary angiography, the patients were divided into three groups based on the number of artery lesions： the single group （156 cases）, the double group （64 cases） and the triple group （58 cases）. The relationship between the severity of coronary artery lesions and the following factors were observed： HbAlc, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, hemoglobin （Hb）, serum uric acid （UA）, total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, body mass index （BMI）, smoking history, drinking history and family history of early coronary artery disease. Results a） HbAlc levels were gradually raised in all the three groups, but the single group （6.39±1.67%） was significantly lower than the double group （6.91±1.63%） and the triple group （7.41±2.12%）, with significant differences （P〈0.05）; the HbAlc level of the single group was significantly lower than the triple group in both the ST-segment elevation AMI （6.42±1.68% vs. 7.17±1.86%, P〈0.05） and the non-ST-segment AMI （5.57±0.37% vs. 8.56±2.83%, P〈0.05）; the HbAlc level of the single group was significantly lower than the triple group in patients with diabetes millitus （8.31±1.83% vs. 8.59±2.02%, P〈0.05） and in patients without diabetes millitus （5.56±0.33% vs. 5.74±0.37%, P〈0.05）; b） There were significant differences in SBP, TC, HDL-C, LDL-C and drinking history between the single group and the other two groups （all P〈0.05）, and there were significant differences in DBP and TG between the single group and the double group （all P〈0.05）; and c） The results of logistic regression analysis showed that, LDL-C （OR=1.790）, HbAlc （OR=1.287） and SBP （OR=1.042） were the independent risk factors （all P〈0.05） for multiple lesions in coronary arteries of young men with AMI. Conclusion Glycosylated hemoglobin Alc is an independent risk factor for multiple lesions in coronary arteries of young men with AMI.