糖化血红蛋白与冠心病并2型糖尿病患者冠状动脉病变复杂程度的关系研究

Relationship between HbA_(1c) and Complexity Level of Coronary Artery Lesions in Coronary Heart Disease Patients Merged with Type 2 Diabetes Mellitus

目的探讨糖化血红蛋白(HbA_(1c))与冠心病并2型糖尿病患者冠状动脉病变复杂程度的关系。方法选取2017年1月—2018年1月在武警后勤学院附属医院行冠状动脉造影检查的冠心病并2型糖尿病患者282例,根据冠状动脉病变复杂程度分为中低危组(SYNTAX积分≤32分)210例和高危组(SYNTAX积分>32分)72例。比较两组患者一般资料、心功能指标及实验室检查指标;HbA_(1c)与冠心病并2型糖尿病患者冠状动脉病变复杂程度的关系分析采用多因素Logistic回归分析,HbA_(1c)与冠心病并2型糖尿病患者SYNTAX积分的相关性分析采用Pearson相关分析,绘制ROC曲线以评价HbA_(1c)对冠心病并2型糖尿病患者高危冠状动脉复杂病变的预测价值。结果 (1)两组患者性别、高血压发生率、高脂血症发生率、吸烟率、早发冠心病家族史、收缩压(SBP)、舒张压(DBP)及左心室舒张末期内径(LVEDD)比较,差异无统计学意义(P>0.05);高危组患者年龄大于中低危组,体质指数(BMI)高于中低危组,左心室射血分数(LVEF)低于中低危组(P<0.05)。(2)两组患者肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、D-二聚体、同型半胱氨酸(Hcy)、肌酐(Cr)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)比较,差异无统计学意义(P>0.05);高危组患者超敏C反应蛋白(hs-CRP)和HbA_(1c)高于中低危组(P<0.05)。(3)多因素Logistic回归分析结果显示,HbA_(1c)是冠心病并2型糖尿病患者冠状动脉病变复杂程度的独立影响因素[OR=7.592,95%CI(1.390,41.438),P<0.05]。(4)Pearson相关分析结果显示,HbA_(1c)与冠心病并2型糖尿病患者SYNTAX积分呈正相关(r=0.545,P<0.001)。(5)ROC曲线显示,HbA_(1c)预测冠心病并2型糖尿病患者高危冠状动脉复杂病变的曲线下面积为0.883,最佳截断值为6.30%,灵敏度为80.6%,特异度为78.1%。结论 HbA_(1c)是冠心病并2型糖尿病患者冠状动脉复杂程度的独立影响因素,且与冠状动脉复杂程度呈正相关,HbA_(1c)≥6.30%对冠心病并2型糖尿病患者高危冠状动脉复杂病变具有一定预测价值。

ObjectiveTo explore the relationship between HbA1c and complexity level of coronary artery lesions in coronary heart disease patients merged with type 2 diabetes mellitus. MethodsA total of 282 coronary heart disease patients merged with type 2 diabetes mellitus were selected in the Affiliated Hospital of Logistics University of the People＇s Armed Police from January 2017 to January 2018,and they were divided into low- and medium-risk group（with SYNTAX score equal or less than 32,n=210）and high-risk group（with SYNTAX score over 32,n=72）according to the complexity level of coronary artery lesions. General information,index of cardiac function and laboratory examination results were compared between the twogroups;relationship between HbA1c and complexity level of coronary artery lesions in coronary heart disease patients merged with type 2 diabetes mellitus was analyzed by multivariate Logistic regression analysis,Pearson correlation analysis was used to analyze the correlation between HbA1c and SYNTAX score in coronary heart disease patients merged with type 2 diabetes mellitus,and ROC curve was drawn to evaluate the predictive value of HbA1c on high-risk coronary artery complex lesions. Results（1）No statistically significant differences of gender,incidence of hypertension or hyperlipidaemia,smoking rate,family history of premature coronary heart disease,SBP,DBP or LVEDD was found between the two groups（P〉0.05）;age in high-risk group was statistically significantly older than that in low- and medium-risk group,BMI in high-risk group was statistically significantly larger than that in low- and medium-risk group,while LVEF in high-risk group was statistically significantly lower than that in low- and medium-risk group（P〈0.05）.（2）No statistically significant differences of CK,CK-MB,LDH,D-dimer,Hcy,Cr,FPG,TC,TG,HDL or LDL was found between the two groups（P〉0.05）,while hs-CRP and HbA1c in high-risk group were statistically significantly higher than those in low- and medium-risk group （P〈0.05） .（3）Multivariate Logistic regression analysis results showed that,HbA1c was one of independent influencing factors of complexity level of coronary artery lesions in coronary heart disease patients merged with type 2 diabetes mellitus〔OR=7.592,95%CI（1.390,41.438）,P〈0.05〕.（4）Pearson correlation analysis results showed that,HbA1c was positively correlated with SYNTAX score in coronary heart disease patients merged with type 2 diabetes mellitus（r=0.545,P〈0.001）.（5）ROC curve showed that,AUC of HbA1c in predicting high-risk coronary artery complex lesions was 0.883 in coronary heart disease patients merged with type 2 diabetes mellitus,the optimum truncation value was 6.30%,the sensitivity was 80.6%,the specificity was 78.1%. ConclusionHbA1c is one of independent influencing factors of complexity level of coronary artery lesions in coronary heart disease patients merged with type 2 diabetes mellitus,which is positively correlated with complexity level of coronary artery lesions;HbA1c equal or over 6.30% has certain predictive value on high-risk coronary artery complex lesions in coronary heart disease patients merged with type 2 diabetes mellitus.