HbA1c与冠状动脉病变部位及程度的关联分析

Association between HbA1c and the severity of coronary artery in cornary artery disease in China

目的:本研究通过观察糖尿病前期患者中HbA1c水平及冠状动脉(冠脉)造影结果,明确HbA1c与冠脉病变程度及部位间的关联。方法:连续入选142例经冠脉造影确诊的冠心病患者,同时空腹血糖及口服糖耐量试验诊断为糖尿病前期状态。根据HbA1c水平分为3组:A组,HbA1c≤5.5%;B组,5.5%<HbA1c≤6.0%;C组,6.0%<HbA1c<6.5%。计算Gensini积分及冠脉病变血管数,比较各组间冠脉Gensini积分及病变血管数差异,并评价HbA1c与积分间的关联。结果:随着HbA1c水平的升高,冠脉病变血管数量也有所增加(P<0.05),C组与A组和B组比较,3支血管病变的比例最高(38%∶23%∶10%,P=0.008);随着HbA1c水平的升高,冠脉Gensini积分也逐渐升高,C组明显高于其余两组[(11.52±7.56)∶(9.60±4.92)∶(6.99±4.42),P=0.002];而且HbA1c与冠脉Gensini积分有明显关联(回归系数0.29;P=0.001)。研究发现HbA1c水平与冠脉病变部位(近端/远端)无明显关联(P>0.05)。结论:在冠心病合并糖尿病前期患者中,HbA1c水平是冠脉病变程度的独立危险因素。

Objective：To investigate the association between the level of HbA1c in serum and the severity of coronary artery in corrnary artery disease（CHD）in China.Method：Consecutive 142 prediabetic patients with coronary artery disease were divided into three groups：group A,HbA1c≤5.5%;group B,5.5%HbA1c≤6.0%; group C,6.0%HbA1c6.5%.The severity and extent of coronary atherosclerosis were defined as the number of diseased vessels and the Gensini score.We compared the Gensini score and the number of diseased vessels and analyzed the association between HbA1cand the Gensini score.Result：The proportion of triple vessel disease was the highest in group C than that in group B and group A（38%vs 23%vs 10%,P=0.008）.The Gensini score in group C was significantly higher than that group A and B[（11.52±7.56）vs（9.60±4.92）vs（6.99±4.42）; P=0.002].HbA1clevel was significantly associated with the Gensini score（standardized coefficients.0.29;P= 0.001）.However,there is no significant association of HbA1cand the site of the coronary atherosclerosis（proximal or distal involvement）（P0.05）.Conclusion：HbA1c is an independent risk factor for the severity of coronary artery in corrnary artery disease（CHD）in China.