冠心病患者糖耐量变化与冠状动脉病变之间的关系分析

Relationship between glucose tolerance changes and coronary pathological changes in patients with coronary heart disease

目的探讨冠心病患者糖耐量变化与冠状动脉病变之间的关系。方法 200例确诊为单纯冠心病患者分为糖耐量值正常(NGT)组132例,冠心病合并糖耐量异常(IGT)组35例,冠心病合并2型DM(T2DM)组33例。全部患者均行冠状动脉造影(CAG)与口服75g葡萄糖耐量试验,对患者血糖、胰岛素以及血脂含量进行检测。冠状动脉病变程度用CAG进行分析,冠状动脉狭窄程度按照美国心脏病学会分类标准进行分类与评价。结果①NGT、IGT与DM组糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2小时血糖(PBG)、甘油三酯(TG)、高密度脂蛋白(HDL-C)差异有统计学意义(P<0.05),IGT组与NGT在空腹胰岛素(FINS)差异有统计学意义(P<0.05);②NGT、IGT与DM组右冠动脉(RCA)、左前降支冠状动脉(LAD)、左主干(LMT)相比,两两之间差异均具有统计学意义(P<0.05),左回旋支(LCX)、总狭窄指数以及冠状动脉远端病变方面,IGT组与DM组较NGT组,差异均具有统计学意义(P<0.05);③DM组Gensini积分为(144.32±22.90)分,IGT组为(94.29±16.83)分,NGT组(67.77±12.32)分,DM组与IGT组和NGT组比较,Gensini积分差异有统计学意义,但DM与IGT组间比较,差异无统计学意义(P>0.05)。结论冠心病糖耐量变化与冠状动脉病变间具有一定的关联性,餐后高血糖可能是冠心病发生发展的主要原因。

Objective To investigate the relationship between glucose tolerance changes and coronary pathological changes in patients with coronary heart disease.Methods The study enrolled 200 cases of patients diagnosed with simple tolerance value normal （NGT group,n=132） and coronary heart disease with impaired glucose tolerance （IGT group,n=35）,the coronary heart disease group （T2DM group,n=33）.All patients underwent coronary angiography（CAG） 75 g oral glucose tolerance test to detect blood glucose,insulin and lipid content.The degree of coronary artery disease on CAG analysis,classification and evaluation of the extent of coronary stenosis were classified in accordance with the were statistical differences among NGT,IGT and DM groups except hemoglobin（HbA1c）,fasting blood glucose（FBG）,2 hours postprandial blood glucose（PBG）,triglyceride（TG） and high density lipoprotein cholosterol（HDL-C）（P〈0.05）.There were significant differences between IGT and difference of right coronary artery（RCA）,left anterior descending coronary artery（LAD）,left main trunk（LMT） between any two of the three groups （P〈0.05）.There were statistical difference of the left circumflex coronary artery（LCX）,total stenosis index,and coronary artery distal lesions in the IGT score of DM group was （144.32±22.90） points,that of IGT group was （94.29±16.83）points,and that of NGT group was（67.77±12.32）points.There was statistical difference of Gensini score in the DM,IGT group by comparison with the NGT group （P〈0.01）,but there was no statistical difference between the DM and the IGT group（P〉0.05）.Conclusion There is correlation between glucose tolerance changes and pathological changes in patients with coronary heart disease.Postprandial hyperglycemia may be the main reason for the development of coronary heart disease.