急性冠脉综合征患者糖代谢异常与冠脉病变程度及预后的相关性分析

Correlation of abnormal glucose metabolism with the arterial pathological severity and prognosis in acute coronary syndrome

目的探讨急性冠脉综合征(ACS)患者糖代谢异常与冠脉病变程度及预后的相关性。方法选取500例既往无糖尿病史ACS患者为研究对象,对其冠状动脉病变进行Gensini评分。根据口服糖耐量试验(OGTT)结果将所有患者分为血糖正常组145例、空腹血糖受损(IFG)组110例、糖耐量受损(IGT)组115例和糖尿病(DM)组130例。比较四组临床资料、冠脉狭窄分数、血糖变异系数和不良事件发生率,并采用Logistic多因素回归分析影响ACS预后的因素。结果 IGT组和DM组Gensini评分高于血糖正常组和IFG组(P<0.05),IGT组与DM组Gensini评分比较及血糖正常组与IFG组Gensini评分比较均无显著性差异(P>0.05);与血糖正常者相比,IGT组和DM组心血管事件、冠脉狭窄分数和血糖变异系数均显著增高(P<0.05或P<0.01),但与IFG组无显著性差异(P>0.05);Logistic多因素回归分析结果显示,糖尿病、Gensini评分、平均血糖水平、高血糖病程、血糖变异系数均为影响糖代谢异常ACS患者致死率的危险因素(P<0.05)。结论 ACS糖代谢异常与冠脉病变程度呈正相关关系,且预后较差。

Objective To explore the correlation between abnormal glucose metabolism,arterial pathological severity and prognosis in acute coronary syndrome (ACS) patients.Methods The clinical data on 500 cases of ACS without known diabetes mellitus history were retrospectively reviewed to evaluate the arterial pathological grade with Gensini score. According to oral glucose tolerance test (OGTT),all the subjects were divided into normal blood glucose group(n=145),fasting blood glucose impaired(IFG) group(n=110), impaired glucose tolerance(IGT)group (n=115)and diabetic(DM)group(n=130). Comparisons of clinical features,coronary stenosis score,variable coefficient of blood glucose and adverse events incidences of the four groups were done by multiple regression analysis to discover the prognostic factors.Results The Gensini scores of IGT and DM groups were higher than those of normal blood glucose group and IFG group( P <0.05).There was no significant difference in Gensini score between IGT group and DM group as well as normal blood glucose group and IFG group( P >0.05). Cardiovascular adverse events,coronary stenosis scores and blood glucose variable coefficient in IGT group and DM group statistically increased( P <0.05 or P <0.01 ),but no significant difference in IFG group( P >0.05)compared with the normal glucose group.Multiple regression analysis showed that Gensini score,mean blood glucose concentration,hyperglycemia duration and the variable coefficient blood glucose were significantly corelated with the risk of cardiovascular adverse events in ACS patients( P <0.05).Conclusion The abnormal glucometabolic status in ACS is positively correlated with the severity of coronary artery disease,which will lead to a poor ACS prognosis.