颈动脉中层内膜厚度和C反应蛋白预测不同糖调节受损者冠状动脉病变程度

Carotid artery intima-media thickness and C-reactive protein in predicting coronary lesions in patients with differently impaired glucose regulation

目的探讨颈动脉中层内膜厚度(CIMT)、C反应蛋白(CRP)推断不同糖调节受损(IGR)患者冠状动脉病变程度的临床意义。方法 160例疑似冠状动脉性心脏病行冠状动脉造影检查者根据口服葡萄糖耐量试验的结果进行分组:正常糖代谢(NGT)组42例,空腹血糖调节受损(IFG)组36例,葡萄糖耐量减低(IGT)组42例,IFG+IGT组40例。检测体质指数(BMI)、血压、血脂、胰岛素、CRP、CIMT,采用Gensini积分系统进行评分。结果除IGT组与IFG+IGT组间冠状动脉性心脏病发生率、CRP水平的差异无统计学意义(P值均>0.05)外,其余两两组间的差异均有统计学意义(P值分别<0.05、0.01)。IGT组、IFG+IGT组的Gensini评分和CIMT均显著高于NGT组(P值分别<0.05、0.01),IFG+IGT组均显著高于IFG组(P值均<0.05)。单因素分析显示,Gensini评分与餐后2h血糖(r=0.536)、稳态模型胰岛素抵抗指数(HOMA-IR,r=0.436)、CRP(r=0.298)、CIMT(r=0.516)呈正相关(P值均<0.01),CIMT与HOMA-IR(r=0.364)、CRP(r=0.339)、Gensini评分(r=0.298)呈正相关(P值均<0.01)。多元回归分析显示,HOMA-IR(β=3.886)、CRP(β=3.374)、CIMT(β=3.521)为Gensini评分的独立相关影响因素(P值均<0.01),HOMA-IR(β=5.021)、CRP(β=4.176)为CIMT的独立相关影响因素(P值均<0.01)。结论 CIMT联合CRP能判断不同IGR患者的冠状动脉病变程度。

Objective To investigate the role of the carotid artery intima-media thickness （CIMT） and Creactive protein （CRP） in predicting the coronary lesions in patients with differently impaired glucose regulation （IGR）. Methods Oral glucose tolerance test was performed in 160 patients suspected with coronary heart disease by coronary arteriography. There were 42 patients with normal glucose tolerance （NGT）, 36 with impaired fasting glucose （IFG）, 42 with impaired glucose tolerance （IGT） and 40 with IFG and IGT. Body mass index （BMI）, blood pressure, blood lipid, insulin level, CRP and CIMT were examined. Coronary lesions were evaluated by Gensini score. Results There were significant differences in terms of the incidence of coronary heart disease and CRP between each two groups, except for those between IGT group and IFG＋IGT group （P〈 0.05 or 0.01）. CIMT in IGT and IGT＋ IFG groups were significantly higher than those in NGT group （P〈0.05 and 0.01）. Gensini scores and CIMT in IGT＋IFG group were significantly higher than those in IFG group （P〈0.05）. One-way ANOVA indicated that Gensini scores were positively correlated with the 2 hour postpradial glucose 2hPG）, homeostasis model assessment-insulin resistance （HOMA-IR）, CRP and CIMT （r = 0. 536, 0. 436, 0. 298and 0.516, P 〈0.01 ） ; CIMT were positively correlated with the HOMA-IR, CRP and Gensini score （ r = 0. 364, 0.339 and 0.298, all P〈0. 01）. Multiple regression analysis showed that HOMA-IR, ORP and OlMT were independently correlated with the Gensini score （β = 3. 886, 3. 374, and 3. 521, P〈0.01 ）, and HOMA-IR and ORP were independently correlated with the OlMT （β=5. 021 and 4. 176, P〈0.01）. Conclusion The values of OlMT and ORP can help to predict the level of coronary lesions in IGR patients.