OGTT筛查及生活方式干预对青年冠心病患者的作用研究

Clinical Significance of OGTT and Lifestyle Intervention for Young Patients with Coronary Artery Disease

目的探讨青年冠心病患者糖耐量试验(OGTT)筛查及生活方式干预的意义。方法对270例年龄≤45岁的冠心病患者行OGTT筛查,并分为糖尿病组、糖耐量异常组、正常血糖组,分析各组冠状动脉病变严重程度。根据患者意愿及对生活方式干预措施的执行能力将糖代谢异常(糖尿病组+糖耐量异常组)患者分成对照组和干预组,3个月后比较两组治疗前后OGTT(0,2h),糖化血红蛋白(HbA1c)、体重指数。结果多支冠状动脉病变发生率糖尿病组81.4%,糖耐量异常组75.6%,血糖正常组37.9%。冠状动脉病变糖尿病组与糖耐量异常组类似,显著较正常组严重(P<0.01)。干预组治疗前后空腹血糖、餐后2h血糖、HbA1c、体重指数比较差异有显著统计学意义(均P<0.01)。结论 OGTT筛查有助于发现糖尿病前期病变。糖尿病及糖耐量异常者冠状动脉病变严重。生活方式干预能明显降低血糖,延缓2型糖尿病的发生。

Objective To evaluate clinical significance of oral glucose tolerance test （OGTT） and lifestyle intervention in young patients with coronary artery disease （CAD）. Methods 270 patients≤45 years of age with CAD received OGTT. They were diagnosed as having diabetic mellitus （DM）, impaired glucose tolerance （IGT） or normal blood glucose （BG）. The severity of CAD was analyzed. According to patient＇s intention and ability to execute lifestyle intervention, those with DM and IGT were divided into interventional group and control group. OGTT, BG, HbA1c, body mass index were compared before and after 3 months of intervention. Results Multiple-vessel disease was found in 81.4%patients with DM, 75.6% with IGT and 37.9% with normal BG. The extent of CAD was similar between patients with DM and IGT, but more significant than that of patients with normal BG （P〈0.01）. There were significant differences of fast BG, BG 2 hours after meal,HbA1c and body mass index before and after lifestyle intervention （al P〈0.01）. Conclusion OGTT is useful for detecting prediabetes. Patients with DM or IGT had extensive and serious coronary artery disease. Lifestyle intervention can obviously reduce BG and delay development of type 2 diabetes.