糖化血红蛋白A1c浓度与非糖尿病患者冠状动脉粥样硬化性心脏病严重程度的关系

Relationship between concentration of glycated hemoglobin A1c and severity of coronary artery disease in patients with non-diabetics

目的探讨糖化血红蛋白(glycated hemoglobin,Hb A1c)浓度与非糖尿病患者冠状动脉粥样硬化性心脏病(冠心病)严重程度的相关性。方法采用回顾性分析方式,收集在广东省人民医院行冠状动脉造影且不合并糖尿病的患者573例。收集所有入选患者基线资料。将患者分为冠心病组和无冠心病组,然后再将冠心病组患者分为单支血管病变亚组和多支血管病变亚组。依据出院诊断结果将冠心病组患者分为稳定性冠心病亚组,不稳定性冠心病亚组和急性心肌梗死亚组。探讨Hb A1c浓度和冠状动脉狭窄程度以及临床症状严重程度的相关性。结果 (1)共有573例患者入选本研究,其中107例经冠状动脉造影排除冠心病,466例冠状动脉造影证实存在冠状动脉狭窄。与无冠心病组相比,冠心病组患者年龄较大、男性较多、吸烟人数较多,血浆高密度脂蛋白胆固醇和载脂蛋白A浓度较低、C反应蛋白浓度和Hb A1c浓度较高,差异有统计学意义(P<0.05)。(2)急性心肌梗死亚组和不稳定性冠心病亚组Hb A1c浓度显著高于稳定性冠心病亚组;急性心肌梗死亚组Hb A1c浓度显著高于稳定性冠心病亚组,差异均有统计学意义(P>0.05)。(3)多支血管病变亚组Hb A1c浓度高于单支血管病变亚组,差异均有统计学意义(P>0.05)。(4)多因素回归分析提示校正传统危险因素后,Hb A1c浓度与冠心病严重程度仍具有独立相关性。结论 Hb A1c浓度可以用于评估非糖尿病冠心病患者的心血管风险。

Objectives To investigate the relationship between serum concentration of glycated hemoglobin（Hb A1c）and severity of coronary artery disease（CAD）. Methods Retrospective study was conducted and non-diabetic participants with CAD were enrolled and baseline characteristics were collected. All participants were performed coronary angiography to figure out the numbers of coronary artery stenosis in terms of none-stenosis（〈50% stenosis）,single or multiple vessels stenoses（≥50 % stenosis）. All participants were divided into subgroups according to two categories in terms of severity of clinical presentation（stable angina, unstable angina, or acute myocardial infarction）and the number of coronary artery stenosis（none, single and multiple vessels）. Relationship between baseline serum concentration of Hb A1 c and severity of CAD was evaluated. Results（1）Totally 573 subjects were enrolled, among them,107 were ruled out CAD and 466 were diagnosed as coronary artery stenosis according to coronary angiographic examination. Participants with CAD had more risk factors such as elderly, smoking, and lower serum concentration of high-density lipoprotein-cholesterol and apolipoprotein-A,higher serum concentration of C-reactive protein. Notably,serum concentration of Hb A1 c was more prominent in CAD group than that without CAD.（2）As compared to stable angina subgroup,serum concentrations of Hb A1 c were gradually increased in unstable angina and acute myocardial infarction subgroup.（3）Similar trend was identified in another category in terms of higher serum concentrations of Hb A1 c corresponding to more vessels stenoses. And serum concentration of Hb A1 c was higher in acute myocardial infarction subgroup than that in stable angina subgroup.（4）Multivariate regression analysis showed that after adjusted for traditional risk factors as well as fasting blood glucose, Hb A1 c remained strongly associated with the severity of CAD.Conclusions Hb A1 c may be a useful indicator for CAD risk evaluation in non-diabetic adults.