伴糖耐量减低的冠心病患者临床特征及病变特点分析

Analysis of the Clinical Features and Lesion Characteristics of Patients with Coronary Heart Disease Accompanied by Abnormal Glucose Tolerance

目的探讨伴有糖耐量减低(IGT)的冠心病患者的临床特征及冠状动脉病变特点。方法选取260例行冠状动脉造影检查的冠心病患者,根据1999年WHO的诊断标准分为三组,不伴糖代谢异常者(NGT组)90例,伴糖耐量减低者(IGT组)86例,伴糖尿病者(DM组)84例,化验空腹血糖(FBG)、餐后2小时血糖(2HPG)、血脂水平、肾功能,分析各组冠心病患者的临床类型、比较各组生化指标及冠脉病变支数、冠脉积分的差异。结果 IGT及DM组患者不稳定性心绞痛(UAP)、非ST段抬高型心肌梗死(NSTEMI)的发生率显著高于NGT组(P<0.05),ST段抬高型心肌梗死(STEMI)的发病率显著低于NGT组(P<0.05)。IGT及DM组患者的FBG、2HPG、血尿酸(UA)和甘油三酯(TG)水平明显高于NGT组(P<0.05)。三组血清尿素氮(BUN)、肌酐(CELRA)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDLC)差异无显著性(P>0.05)。IGT及DM组患者冠脉0支病变、单支病变的发生率低于NGT者,而冠脉双支病变、三支病变及冠脉积分显著高于NGT者(P均<0.05)。结论伴IGT的冠心病患者,非ST段抬高急性冠脉综合征发生率更高,冠脉病变多为多支病变及弥散性病变,及早发现并积极干预,有助于降低糖代谢异常对心血管系统的损害。

Objective To explore the clinical features of patients with coronary heart disease（CHD） accompanied by abnormal glucose tolerance and their lesion characteristics.Method 260 cases with CHD who received coronary angiography were divided into three groups：90 cases with abnormal glycometabolism;86 cases with abnormal glucose tolerance;84 cases with concurrent diabetes mellitus（DM）.These patients were examined in terms of fasting blood sugar,indices of serum lipid,renal function,and blood sugar 2 hours after meal,so as to analyze their differences in clinical type,test result,number of coronary lesion vessels,coronary artery score.Result The incidence rates of unstable angina and non-ST segment elevation myocardial infarction（STEMI） in patients with abnormal glucose tolerance and patients with DM were higher than those in patients with no abnormal glycometabolism（P0.05）,and the incidence rates of STEMI in patients with abnormal glucose tolerance and with DM were lower than those in patients with no abnormal glycometabolism（P0.05）.The blood sugar,blood sugar 2 hours after meal,uric acid,and serum triglyceride of patients with bnormal glucose tolerance and with DM were higher than those in patients with no abnormal glycometabolism（P0.05）.There were no statistically significant differences in urea nitrogen,creatinine,total cholesterol,high-density lipoprotein cholesterol and low density lipoprotein cholesterol in serum among the three groups（P0.05）.The lesion of the zero branch and the single branch in patients with abnormal glucose tolerance and patients with DM were lower than those in patients with no abnormal glycometabolism.The lesion of the double branch and the three branch in patients with abnormal glucose tolerance and patients with DM were higher than those in patients with no abnormal glycometabolism.The Coronary integral in patients with abnormal glucose tolerance and patients with DM were higher than those in patients with no abnormal glycometabolism（all P0.05）.Conclusion The incidence rate of non-ST segment elevation acute coronary syndrome is higher in CHD patients with abnormal glycometabolism,and most of coronary artery lesions are multi-vessel and diffuse lesions.Therefore,early detection of abnormal glucose tolerance and active intervention measures would help reduce the damage to the cardiovascular system caused by abnormal glycometabolism.