负荷后1h血糖与冠脉病变的相关性研究

Correlation between 1-hour post-load plasma glucose and severity of coronary artery disease

目的探讨口服葡萄糖耐量试验（OGTT）1 h血糖（1h PG）与冠状动脉病变程度的相关性。方法回顾分析312例拟诊冠心病且既往无糖尿病史患者,并根据OGTT结果除外糖尿病患者后,将OGTT 1h PG分为〈8.6 mmol·L^-1组（157例）和1h PG≥8.6 mmol·L^-1组（98例）。冠状动脉病变程度以冠脉造影结果判断是否诊断冠心病、冠脉病变支数、弥漫性病变情况以及Gensini总评分来表示。比较两组冠心病危险因素和冠脉病变程度,并对1h PG水平与冠脉病变程度进行单因素和多因素分析。结果与1h PG〈8.6 mmol·L^-1组比较,1h PG≥8.6 mmol·L^-1组代谢谱更差,该组患者体重指数、收缩压、空腹血糖、OGTT 2 h血糖、甘油三酯显著升高,而高密度脂蛋白胆固醇（HDL-C）水平显著降低（P〈0.05）;超敏C反应蛋白在后组中也有显著升高。1h PG≥8.6 mmol·L^-1组冠心病患病率、多支病变、弥漫性病变发生率及Gensini总积分明显升高（P〈0.05）,而1h PG〈8.6 mmol·L^-1组患者单支病变发生率明显升高（P〈0.05）。多元回归分析表明hs CRP是1h PG的最强影响因素（β=0.259,P〈0.05）;Logistic回归分析表明1h PG为冠心病独立危险因素（OR值1.043,95%CI：1.051-1.627,P=0.042）。结论负荷后1h PG≥8.6 mmol·L^-1的患者代谢谱更差,可能是前期糖尿病的标志;升高的1h PG与冠状动脉粥样硬化密切相关。

Objective To investigate the correlation between 1-hour post-load plasma glucose（1hPG） and the severity of coronary artery disease（CAD）.Methods A total of 312 patients with suspected coronary heart disease（CHD） and without diabetes history received oral glucose tolerance test（OGTT）.Among them 157 cases had lhPG 8.6 mmol·L^-1 and 98 had lhPG≥8.6 mmol·L^-1.The extent and severity of CAD were assessed by coronary angiography,the number of diseased vessels,diffuse lesions and Gensini total score of CAD were evaluated.The risk factors of CHD and the degree of coronary artery lesion were compared among two groups.The correlation between lhPG and the degrees of coronary artery lesions was analyzed with univariate and multivariate analysis.Results Compared to 1hPG〈8.6 mmol·L^-1 group,patients with 1hPG≥8.6 mmol·L^-1 showed a worse metabolic profile,higher body mass index,systolic blood pressure,fast plasma glucose（FPG）,OGTT 2 hours blood glucose（2hPG）,triglyceride level,and lower HDL-cholesterol level（P〈0.05）.Plasma high-sensitivity CRP（hsCRP） level was higher in lhPG≥8.6 mmol·L^-1 group than that in 1hPG〈 8.6 mmol·L^-1 group（P〈0.05）.Coronary angiography revealed that the prevalence of CHD,the incidence of multi-vessel lesions and diffuse lesions and the score of coronary artery lesion were significantly higher in lhPG≥8.6 mmol·L^-1 group（P〈0.05）,while single-vessel lesions were more frequent in the lhPG8.6 mmol ·L^-1 group（P〈0.05）.Multiple stepwise regression analysis showed that hsCRP was the strongest factor to affect lhPG levels（β=0.259,P〈0.05）.Logistic regression analysis showed that lhPG was the independent risk factor of CHD（OR = 1.043,95%CI：1.051-1.627,P=0.042）.Conclusion CHD patients with lhPG≥8.6 mmol·L^-1have a worse metabolic profile;elevated lhPG is closed related with coronary atherosclerosis and it may be a marker for pre-diabetes.