糖化血红蛋白水平对冠心病合并2型糖尿病患者冠脉病变及急性心肌梗死发生率的影响

Impact of Glycosylated Globin Level in Coronary Heart Disease Patients with Type 2 Diabetes Mellitus on the Characteristics of Coronary Artery Lesions and the Incidence of Acute Myocardial Infarction

【目的】探讨分析糖化血红蛋白水平（HbAlc）对冠心病合并2型糖尿病患者冠脉病变特点及急性心肌梗死（AMI）发生率的影响。【方法】回顾性分析本院2012年1月至2013年2月间收治的150例经冠脉造影确诊为冠心痛患者的临床资料，根据HbAlC水平将其分为三组：A组，45例（单纯冠心病患者，HbAlc〈5．7％）；B组，48例（合并2型糖尿病血糖控制良好组，HbAlc〈6．5％）；C组，57例（合并2型糖尿病血糖控制不佳组，HbAlc≥6．5％）。比较三组患者AMI发生率及冠脉病变特点有无差异。【结果】①．c组AMI发病率显著高于A组和B组，差异均有统计学意义（分别为P〈0．001，P〈0．05）；B组AMI发病率显著高于A组（P〈0．05）。②B、C两组冠脉造影主要表现为多支、多节段弥漫性病变，A组冠脉造影主要表现为单支病变，其次为双支病变，B、c两组多支病变明显高于A组，差异具有统计学意义（P〈0．05），B、C两组冠脉病变支数无统计学意义（P〉0．05），三组病变的血管分布无统计学意义（P〉0．05）。③三组Gensini积分差异显著，具有统计学意义（P〈0．05）。【结论】冠心病合并2型糖尿病患者HbAlC水平控制不佳会增加AMI发病率，加重冠脉病变严重程度。

[Objective] To explore whether the different levels of HbAlc in patients with coronary heart disease affect the incidence and characteristic of coronary artery lesions. [Methods] Retrospective analyses were conducted for the clinical data of 150 cases of coronary artery disease as confirmed by coronary angiography between January 2012 and Pebruary 2013. They were divided into three groups based on the level of glycosycated hemoglobin： A （coronary heart disease without type 2 diabe- tes, HbA1C G5.7%, n =45）, B （coronary heart disease patients wi, th type 2 diabetes mellitus （T2DM） with intensive glyce- mic control, HbA1CG6.50/00, n =48） ; C （coronary heart disease patients with T2DM with poor glycemic control, HbAIC 6.5%, n =57）. And the characteristics of coronary artery lesions and the incidence of acute myocardial infarction. [Results] The incidence of acute myocardial infarction was 45.61% in group C. And it was significantly higher than 11.11% in group A （ P 〈0. 001） and 25.00% in group B （ P 〈0.05）. The incidence of acute myocardial infarction of 250/00 in group B was higher than 11.11% in group A （ P 〈0.05）. The changes of coronary arteries showed multi-vessel, multi-segmental and diffuse le- sions in groups B and C. The coronary angiography of group A showed mostly single-vessel lesion and followed by double-ves- sel disease. There were statistic significances in the number of coronary lesions between groups B and A （ P〈0.05） and groups C and A （ P 〈0.05）. And no statistical significance existed in vascular lesions among three groups （ P 〉0.05）. The Gensini integral of these three groups differed significantly with statistic significance （ P 〈0.05）. [Conclusion]The different levels of HbAlc are closely correlated with the incidence of acute myocardial infarction and the characteristic of coronary artery lesions.