冠心病患者冠状动脉病变与糖耐量变化的关系

The relationship between glucose tolerance and coronary artery lesion in the patients with coronary heart disease

目的 探讨冠心病患者糖耐量变化与冠脉病变之间的关系。方法 193例冠心病患者根据WHO(1985 )和美国糖尿病学会 (1997)糖尿病诊断标准分为单纯冠心病〔糖耐量正常 (NGT)〕组12 2例 ,冠心病合并糖耐量异常 (IGT)组 39例 ,冠心病合并 2型糖尿病 (DM)组 32例 ,所有研究对象均行冠脉造影 (CAG)和口服 75克葡萄糖耐量试验 ,检测血糖、胰岛素、血脂。冠脉病变程度应用CAG分析 ,冠脉狭窄程度根据美国心脏学会分类标准评价 ,冠脉病变的危险因素应用多元逐步直线回归分析。结果 (1)冠心病合并IGT组多支冠脉病变的发生率明显高于单纯冠心病组 (6 6 .5 %vs 35 .1% ,P <0 .0 5 ) ,冠脉狭窄程度 (8.9± 3.6vs 6 .5± 3.9,P <0 .0 5 )及钙化的程度 (6 .3± 3.6vs 3.9± 4 .1,P <0 .0 5 )明显高于单纯冠心病组 ,冠脉远端的病变发生率明显高于单纯冠心病组 (40 .8%vs 13.1% ,P<0 .0 5 )。 (2 )冠心病合并IGT组与冠心病合并DM组相比 ,多支冠脉病变的发生率、冠脉粥样硬化及钙化的程度及冠脉远端的病变发生率差异无显著性。 (3)血脂、胰岛素、血压与冠脉粥样硬化程度有明显相关性。结论 与冠心病合并DM患者相似 ,冠心病合并IGT患者多支冠脉病变的发生率高 ,病变多呈弥漫性狭窄 ,远端血管病变发生率较高 ,程度严重。

Objective To investigate the relationship between glucose tolerance change and the coronary artery lesion in the patients with coronary heart disease. Methods One hundred and ninety three patients with coronary artery disease were divided into 3 groups according to WHO(1985) and American Diabetes Association (1997) standard of diabetic diagnoses: (1) normal glucose tolerance (NGT) group 122 cases; (2) impaired glucose tolerance (IGT) group 39 cases; (3) type 2 diabetes mellitus (DM) group 32 cases. All patients were examined by the coronary angiographic semiquantitative (CAG) and 75 g oral glucose tolerance test. Blood glucose, insulin, triglyceride (TG), total cholesterol (TC) and high density lipoprotein cholesterol (HDL C) were determined. The coronary artery changes were analysed by CAG, and the severity of coronary artery stenosis was evaluated according to American Heart Association standard. The risk factors of coronary artery lesion were analysed by pluralism stepwiss regression analysis. Results The coronary multivessel changes and the severity of coronary artery stenosis and calcification were more frequent in IGT group than those in NGT group (66.5% vs 35.1%, 8.9±3.6 vs 6.5±3.9, 6.3±3.6 vs 3.9±4.1 respectively, P<0.05). Distal coronary change was more frequent in IGT group than that in NGT group. There was no significant difference of the above changes between IGT group and DM group. Blood TG, TC, insulin and blood pressure were positively and HDL C was negatively correlated with the coronary artery lesion. Conclusion There are similar morbidity and severity of coronary artery lesion in IGT and DM groups. The coronary multivessel lesion and distal coronary and diffusing stenosis are more frequent in IGT or DM group than those in NGT group. Dyslipidemia, hyperinsulinemia and hypertension are independent risk factors for coronary artery disease.