不同糖耐量冠心病患者的临床及冠状动脉造影特征研究

Clinical and Coronary Angiography Characteristics of Coronary Heart Disease Patients with Different Glucose Tolerance

目的研究不同糖耐量的冠心病患者临床、实验室指标、冠状动脉造影等各方面的特征,探讨血糖及相关危险因素对冠心病患者病情和预后的影响。方法选择于我院心内科住院并行冠状动脉造影确诊为冠心病的患者143例,按照血糖水平分为单纯冠心病组(冠心病组)56例、冠心病合并糖调节受损组(糖调节受损组)32例、冠心病合并糖尿病组(糖尿病组)55例。比较其临床资料及冠状动脉病变的差异,并进行危险因素的Logistic回归分析。结果冠心病组单支、两支、三支病变的构成比分别为46.4%、35.7%和17.9%,糖调节受损组分别为18.7%、37.5%和43.8%,糖尿病组分别为18.2%、25.4%和56.4%,3组比较差异有统计学意义(P<0.05)。冠心病组中度狭窄、重度狭窄和完全闭塞的构成比分别为41.1%、51.8%和7.1%,糖调节受损组分别为53.1%、46.9%和0,糖尿病组分别为7.3%、74.5%和18.2%,3组间差异有统计学意义(P<0.05)。3组弥漫性病变发生率分别为17.9%、43.8%和45.5%,差异有统计学意义(P<0.05)。糖尿病病程、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、总胆固醇(TC)是冠状动脉三支病变的独立危险因素,FPG、2 hPG是弥漫性病变的独立危险因素,TC是重度狭窄的独立危险因素(P<0.05)。结论糖调节受损或糖尿病均加重冠状动脉病变程度;FPG、2 hPG是冠状动脉三支病变与弥漫性病变共同的独立危险因素。

Objective To investigate the characteristics of the coronary heart disease （CHD） with different glucose tolerance in clinical presentation, laboratory tests and coronary angiography, so as to study the influence of plasma glucose and other risk factors on the condition and prognosis of the CHD patients. Methods A total of 143 CHD patients confirmed with coro- nary angiography and hospitalized in the Cardiology Department of our hospital were enrolled. They were divided into three groups according to different plasma glucose levels, namely simple coronary heart disease （CHD） group （ n = 56）, coronary heart dis- ease with impaired glucose regulation （IGR） group （ n = 32）, coronary heart disease with diabetes mellitus （DM） group （ n = 55 ）. The differences in clinical data and coronary artery lesions among the three groups were compared, and Logistic regression analysis was conducted about risk factors. Results The constituent ratios of lesions of single -, double -, and triple - branch coronary artery were respectively 46.4%, 35.7% and 17.9% in CHD group ; 18. 7%, 37. 5% and 43.8% in IGR group ; and 18. 2%, 25.4% and 56.4% in DM group （P 〈0. 05）. The constituent ratios of moderate and severe stenosis as well as total oc- clusion of coronary vessel were respectively 41.1%, 51.8% and 7.1% in CHD group; 53. 1%, 46. 9% and 0 in IGR group; and 7. 3%, 74.5% and 18.2% in DM group （P 〈 0.05 ）. The incidence of diffuse vascular lesions in the 3 groups were respec- tively 17. 9%, 43.8% and 45.5% （P 〈 0.05 ）. Duration of diabetes, fasting blood glucose （ FPG）, 2 - hour postprandial blood glucose （2 hPG） and total cholesterol （TC） were independent risk factors for triple -branch lesion of coronary artery; FPG and 2 hPG were independent risk factors for diffuse lesion of coronary artery; and TC was an independent risk factor for se- vere stenosis of coronary artery （P 〈 0. 05）. Conclusion IGR or DM can both aggravate the degree of coronary lesion. FPG and 2 hPG are the independent risk factors for triple - branch lesion and diffuse lesion of coronary artery.