他汀强化治疗的2型糖尿病患者并发冠心病的危险因素分析

Analysis of Risk Factors for Coronary Artery Disease in Type 2 Diabetic Patients Received Aggressive Lipid-modifying Therapy

目的探讨他汀治疗的糖尿病患者发生冠心病(CAD)的残余风险.方法入选进行冠脉造影及介入治疗并在人院前已强化他汀调脂治疗且LDL-C达标(<2.6 mmol/L)的2型糖尿病(T2DM)患者290例,按冠脉造影结果分为糖尿病并冠心病组200例,进一步按冠脉病变支数分为3个血管病变亚组,无冠脉病变者90例为对照组,Logistic回归分析发生CAD的残余风险.结果 Logistic回归分析显示HbA1c/HDL比值是强化他汀治疗后的T2DM患者发生CAD的独立预测因子(OR=1.45,95%CI1.129-1.863,P=0.004).3-支冠脉病变组HbA1c/HDL比值(8.71±2.46)明显高于2-支病变组(7.26±1.54)及1-支病变组(6.80±2.00).HbA1c/HDL比值与冠脉病变广泛程度指数(Pearson’s r=0.516,P<0.01)及冠脉病变支数(Spearman’s r=0.442,P=0.032)正相关.结论 HbA1c/HDL比值是他汀强化调脂治疗的2型糖尿病患者发生CAD的独立预测因子,并与CAD的严重程度相关.

Objective To investigate the residual risk of CAD occurence in type 2 diabetic patients received aggressive lipid-modifying therapy. Methods 290 diabetic patients who received aggressive lipid-modifying therapy（LDL〈2.6 mmol/L） and coronary angiography or percutaneous coronary intervention were divided into two groups.The experiment group consisted of 200 CAD patients with T2 DM and was subdivided into three diseased coronary arteries subgroups. 90 diabetic patients without CAD were served as control. Multivariate logistic regression model was used to analyze the residual risk for CAD.Results Multivariate logistic regression model identified HbA1c/HDL ratio as a independent risk factor for CAD in type 2 diabetic patients who received aggressive lipid-modifying therapy（OR=1.45, 95% CI 1.129-1.863, P =0.004）. HbA1c/HDL ratio were significantly higher in patients with 3-vessel disease（8.71±2.46） compared with those in with 2-vessel（7.26±1.54） and1-vessel disease groups（6.80±2.00,P0.05）,respectively. There were positive correlations of HbA1c/HDL ratio with extent index（Pearson＇s r = 0.516,P〈0.01） and the number of diseased coronary arteries（Spearman＇s r=0.442,P=0.032）.Conclusion HbA1c/HDL ratio was an independent risk factor for CAD in type 2 diabetic patients received aggressive lipid-modifying therapy, and associated with the severity of CAD in type 2 diabetic patients.