不稳定性心绞痛合并糖尿病患者外周反应性充血指数与冠状动脉狭窄程度的关系

Correlation between coronary stenosis degree and reactive hyperemia index in patients with unstable angina pectoris complicating diabetes mellitus

目的血管内皮功能障碍是冠心病发生发展的一个重要环节。文中拟评估合并糖尿病的不稳定性心绞痛(UAP)患者外周反应性充血指数(RHI),并探讨其与冠脉病变程度的关系。方法回顾性分析2016年4月至2016年9月首都医科大学附属北京朝阳医院心内科住院UAP患者300例,按照是否合并糖尿病情况分为合并组(n=122例)和非合并组(n=178例)。应用冠状动脉Gensini评分评估冠状动脉狭窄程度,比较2组患者RHI水平,采用多重线性回归分析RHI与冠状动脉Gensini评分、危险因素的影响关系。结果合并组患者RHI(1.58±0.39)显著低于非合并组(1.70±0.24),差异有统计学意义(P<0.05);合并组患者冠状动脉Gensini评分[(61.76±64.79)分]显著高于非合并组[(37.00±29.79)分],差异有统计学意义(P<0.05)。Gensini评分31~59分患者RHI(1.64±0.28)及≥60分患者RHI(1.58±0.32)均显著低于≤30分患者(1.78±0.23),差异均有统计学意义(P<0.05)。3项及以上危险因素的冠心病患者RHI明显低于具有2项及以下危险因素者[(1.49±0.43)vs(1.63±0.29)],差异有统计学意义(P<0.05)。合并糖尿病患者空腹血糖、糖化血红蛋白、冠状动脉Gensini评分、吸烟、危险因素数量均为RHI的影响因素(P<0.05)。结论合并糖尿病的UAP患者内皮功能障碍与冠状动脉病变密切相关。严重的内皮功能障碍可能是冠状动脉病变严重的原因之一。

Objective Endothelial dysfunction is an important link in the development of coronary heart disease. The article aimed to evaluate reactive hyperemia index(RHI) level in patients with unstable angina pectoris(UAP) complicating diabetes mellitus(DM) and investigate its relationship with the degree of coronary artery stenosis. Methods TThe patients(n=300) diagnosed as UAP by coronary angiography (CAG) in our department were chosen and divided into DM group (UAP complicating DM, n=122) and NDM group(without DM, n=178). The severity of coronary artery stenosis was evaluated using the angiographic Gensini score. RHI levels were compared between two groups. Multiple linear regression analysis was used to analyze the correlations between RHI, angiographic Gensini score and risk factors. Results RHI level of DM group was found to be lower than that of NDM group(1.58±0.39 vs 1.70±0.24,P<0.05). Angiographic Gensini score was significantly elevated in DM group compared to NDM group[Gensini score:(61.76±64.79) vs (37.00±29.79),P<0.05]. The RHI levels of patients with Gensini scores of 31-59 points(1.64±0.28)and above 60 points (1.58±0.32) were significantly lower than those with scores less than 30 points (1.78±0.23)(P<0.05). The RHI level of patients with coronary heart disease(CHD) with three or more risk factors (1.49±0.43) was significantly lower than that of CHD patients with two or less risk factors (1.63±0.29)(P<0.05). Fasting blood glucose, glycosylated hemoglobin, coronary Gensini score, smoking and risk factors in the combined group were all negatively correlated with RHI(β=-0.010;-0.001;-0.177;-0.126;-0.001). Conclusion Gensini integrals are closely co-related to the degree of endothelial dysfunction, and severe endothelial dysfunction may be one cause of exacerbated coronary stenosis in the patients with UAP complicating DM.