糖尿病与冠状动脉狭窄程度的关系

Relationship between diabetes mellitus and severity of coronary artery stenosis in patients with coronary artery disease

目的 :探讨糖尿病 (DM)及其危险因素与冠状动脉狭窄程度的关系。方法 :对经冠状动脉造影证实的冠心病住院患者 2 1 4例进行包括血压、吸烟、糖尿病调查及血糖、血总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、载脂蛋白A1(apoA1)和载脂蛋白B(apoB)水平测定 ,对冠状动脉狭窄程度进行定量Gensini评分 ,分析糖尿病及其血脂代谢因素与冠状动脉病变的关系。结果 :合并糖尿病的冠心病患者 (DM CAD)的冠状动脉积分显著高于无糖尿病者 (nonDM CAD) (P <0 .0 1 )。DM CAD的血TG、LDL C、apoB均显著高于nonDM CAD ,而HDL C、apoA1均显著降低 (P <0 .0 1 ,P <0 .0 5 )。DM CAD的年龄、糖尿病病程、收缩压和舒张压及TG、LDL C、apoB与冠状动脉狭窄程度呈显著正相关 (γ =0 .379～ 0 .4 82 ;P <0 .0 5 ,P <0 .0 1 ) ,而nonDM CAD患者中 ,收缩压、舒张压和累计吸烟量也与冠脉积分相关。无论是否合并糖尿病 ,冠心病患者冠状动脉积分与TG、LDL C、apoB呈显著正相关 (γ =0 .4 72～ 0 .4 84 ,P <0 .0 1 ) ,与HDL C和apoA1呈显著负相关 (γ=-0 .35 6～ -0 .330 ,P <0 .0 1 )。多元回归分析发现 ,糖尿病病程、收缩压和舒张压、TC、TG、LDL C与冠状动脉狭窄程度呈显著正相关 (P

Objective:To study the relationship between coronary risk factors of diabetes mellitus(DM)and the severity of coronary artery stenosis(CAS)in patients with coronary artery disease .Methods:Admitted patients with suspected coronary artery disease(CAD)were studied and were divided into 2 subgroup as DM CAD group ( n =66) and nonDM CAD group ( n =148). All the patients underwent selective coronary angiography, survey of smoking, blood pressure, DM and examination of blood glucose,lipid,lipoprotein and apolipoprotein during the hospitalization.The severity of CAS was quantified in a modified Gensini score. Subsequently,the relationship between diabetes mellitus such as lipid as coronary risk factors and the severity of CAS was anlyzed.Results:The course of DM and coronary artery Gensini score were significantly higher in DM CAD group than that in nonDM CAD group( P <0.05).Compared with nonDM CAD group, the blood glucose, serum total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL C) and apolipoprotein B (apoB) were higher in DM CAD group, while high density lipoprotein cholesterol (HDL C), apolipoprotein A 1 (apo A 1) were lower ( P <0.01 or P <0.05).A significant positive correlation (γ=0.379～0.484, P <0.01)of the severity of CAS to age,the course of DM, TG, LDL C and apoB was found on the basis of the correlation analysis. The negative correlation of CAS severity and HDL C, apoA 1 (γ=-0.356～-0.330, P <0.01) was also observed.Multiple regression analysis indicated that the course of DM, TC, TG and LDLC were positively correlated to CAS, but HDL C and apoA 1 were negatively related to CAS.Conclusion:The severity of CAS was more serious in coronary artery disease patients with DM.Age,the course of DM and their blood lipid such as TC,TG and lipoprotein (LDL C and HDL C) play very important role in coronary artery stenosis.