糖代谢正常冠状动脉性心脏病患者随访3年内的糖代谢变化对预后的影响

Effect of glucose metabolism change within 3-year follow-up on prognosis in patients with coronary artery disease and normal glucose metabolism

目的对糖耐量正常(NGM)的冠状动脉性心脏病患者进行随访,观察糖代谢异常发生情况及其对预后的影响。方法 310例NGM的冠状动脉性心脏病患者出院后定期行门诊随访和电话随访,每6个月行简化75g口服葡萄糖耐量试验(OGTT),记录主要心血管事件(MACE):血运重建、心肌梗死和心源性死亡。结果 280例患者随访资料完整,随访率达90.3%,平均随访时间为(22.7±13.4)个月。新发生糖调节受损(IGR)32例[IGR组,包括糖耐量受损(IGT)、空腹血糖受损(IFG)和IGT+IFG],占11.4%,发生率为6.04/100人年;新发生糖尿病(DM)45例(DM组),占16.1%,发生率为8.50/100人年;NGM 203例(NGM组),占72.5%。IGR组、DM组的MACE发生率分别为40.6%(13/32)、46.7%(21/45),均显著高于NGM组的23.2%(47/203,P值分别<0.05、0.01),前两组间的差异无统计学意义(P>0.05)。多因素回归分析显示,年龄(β=0.047)、男性(β=1.496)、心肌梗死(β=1.036)和糖代谢异常(β=0.818)是发生MACE的独立危险因素(P值分别<0.01、0.05)。结论 27.5%的NGM的冠状动脉性心脏病患者在约3年的随访期间出现糖代谢异常,其预后差于NGM者,持续监测冠状动脉性心脏病糖代谢情况可能具有重要的临床意义。

Objective To investigate the late glucose metabolism change and its impact on long-term outcomes in patients with coronary artery disease （CAD） and normal glucose metabolism （NGM）. Methods Simplified oral glucose tolerance test （OGTT） was performed in 310 consecutive patients diagnosed as CAD with NGM before discharge and every 6 months during follow-up. Meanwhile, the major adverse cardiac events （MACEs） including revascularization, recurrent myocardial infarction and cardiac death were recorded. Results A total of 280 patients （90.3%） completed the follow-up. The follow-up duration was （22.70 ± 13.4） months on average. Of the 280 patients, 45 （16. 1%） developed diabetes mellitus （DM group）, 32 （11.4%） developed impaired glucose regulation （IGR group）, including impaired glucose tolerance （IGT）, impaired fasting glucose （IFG） and IGT＋ IFG, and 203 （72.5%） kept NGM （NGM group）. The incidence rates of MACEs in IGR group and DM group were 40.6% （13/32） and 46.7% （21/45）, respectively, which were significantly higher than that in NGM group （23.2%, 47/203, P〈0. 05 or P〈0.01）. However, there was no statistical difference in the incidence of MACEs between IGR group and DM group （P^0.05）. Logistic regression analysis showed that age （β= 0. 047）, male gender （β = 1. 496）, history of myocardial infarction （β = 1. 036） and abnormal glucose metabolism （β=0.818） were independent predictors of MACEs （P〈0.05 or P〈0.01）. Conclusion In our study, 27.5% patients diagnosed as CAD initially with NGM progressed into late abnormal glucose metabolism within 3-year follow-up, and they have rather worse prognosis. Therefore, glycometabolism should be evaluated at regular intervals in patients diagnosed CAD with NGM.