冠心病不合并糖尿病患者HbA1C与冠状动脉病变的关系

Association between HbA1c level and severity of coronary artery lesion in non-diabetic patients with coronary heart disease

探讨对于冠心病不合并糖尿病患者，HbA1c水平与冠状动脉病变之间的相关性。本研究为单中心、回顾性研究，选取2008年1月至2011年11月于天津市胸科医院行冠状动脉造影并确诊为冠心病，行空腹血糖及静脉血HbA1c化验排除糖尿病诊断的患者302例，依据HbA1c水平分为3组：组1（≤5．5％，92例）、组2（5．6％～5．8％，94例）、组3（5．9％～6．4％，116例）。比较各组SYNTAX积分的水平，并应用logistic回归分析对HbA１ｃ与SYNTAX积分间进行相关性分析，且同时校正空腹血糖、血脂、年龄、性别等危险因素。各组间患者SYNTAX积分具有统计学差异（P〈0．01），且呈升高趋势，采用简单回归计算相关系数（r=0．335，P〈0．01），应用二分类logistic回归分析确定HbAｃ１与中高SYNTAX积分具有相关性（OR=5．089，P〈0．05）。提示即使对于不合并糖尿病的冠心病患者，HbA１ｃ水平与冠状动脉病变也显著相关，高水平的HbA１ｃ似可以独立预测冠状动脉病变程度。

To investigate the association between HbA1c level and severity of coronary artery lesion in non-diabetic patients with coronary heart disease. This study was a retrospective and controlled study in a single center. 302 patients were enrolled. Coronary arterial lesion was confirmed by coronary angiography carried out in Tianjin Chest Hospital between January 2008 and November 2011. The patients enrolled should be non-diabetic with normal fasting blood glucose and HbAm levels. The patients were divided into 3 groups according to the HbAlc levels, Group 1 （≤5.5%, n= 92）, Group 2（5.6% -5.8%, n =94）, Group 3 （ 5.9% -6.4%, n = 116 ）, and the SYNTAX scores between the groups were compared. The predictive value of HbAlc in groups with intermediate and high SYNTAX score was identified by Logistic regression analysis while common risk factors such as sex, age, hypertension, lipid, and fasting glucose were adjusted. The SYNTAX score from Group 1 to Group 3 had statistically significant difference（ P〈0.01 ）. Simple regression was used to calculate the correlation coefficient （r = 0. 335, P〈 0.01 ）. Binary Logistic regression was used to confirm that HbA1c level was also associated with intermediate and high SYNTAX score （ OR = 5. 089, P〈0.05 ）. In non-diabetic patients, the HbA1c level is associated with the severity of the lesion of coronary artery. The results indicate that a higher level of HbAlc seems to be an independent predictor to the prevalence of complex coronary lesions.