口服葡萄糖耐量试验在空腹血糖低于7.0 mmol/L冠心病患者中的应用价值

Value of Oral Glucose Tolerance Test on Evaluating Glucose Metabolism Abnormality in Coronary Heart Disease Patients With Fasting Glucose Level Lower Than 7.0 mmol/L

目的:探讨空腹血糖<7.0 mmol/L的不同冠状动脉(冠脉)病变冠心病患者中糖代谢异常的发生情况以及口服葡萄糖耐量试验(OGTT)在这类患者中的应用价值。方法:收集我院心内科2016年1月至2018年9月空腹血糖<7.0 mmol/L的426例冠心病住院患者,根据冠脉造影结果分为冠脉单支病变组(n=110)和冠脉多支病变组(n=316),通过OGTT分析两组患者中糖代谢异常的发生情况。结果:冠脉单支病变组中,糖调节受损54例(49.09%),糖尿病11例(10.00%),糖代谢异常共65例(59.09%);冠脉多支病变组中,糖调节受损180例(56.96%),糖尿病47例(14.87%),糖代谢异常共227例(71.83%)。与冠脉单支病变组比较,冠脉多支病变组患者年龄较大,男性患者较多,体重指数较高,肥胖及超重患者较多,总胆固醇和低密度脂蛋白胆固醇水平较高,有冠心病家族史者较多,糖耐量异常和糖尿病患者较多,差异均有统计学意义(P均<0.05)。Logistic回归分析显示:年龄(OR=1.038,95%CI:1.009~1.068)、吸烟(OR=1.964,95%CI:1.232~3.129)、体重指数(OR=1.662,95%CI:1.181~2.338)、糖耐量异常(OR=1.039,95%CI:1.032~1.224)、糖尿病(OR=1.651,95%CI:1.032~3.109)、冠心病家族史(OR=2.122,95%CI:1.104~4.076)是冠心病患者冠脉多支病变的危险因素。结论:空腹血糖<7.0 mmol/L的冠心病患者中糖代谢异常比例较高,且冠脉多支病变组较冠脉单支病变组存在更多的糖代谢异常。

Objectives:To investigate the status of glucose metabolism in patients with coronary heart disease with fasting blood glucose level below 7.0 mmol/L by oral glucose tolerance test.Methods:A total of 426 coronary heart disease patients with fasting blood glucose below 7.0 mmol/L,who hospitalized in our hospital from January 2016 to September 2018,were enrolled.According to the results of coronary angiography,patients were divided into single-vessel disease(n=110)and multi-vessel disease groups(n=316).Oral glucose tolerance test was performed in all patients to define the glucose metabolism status.Results:There were 54(49.09%)patients with impaired glucose regulation,11(10.00%)patients with diabetes in the single-vessel disease group.There were 180(56.96%)patients with impaired glucose regulation,47(14.87%)patients with diabetes in the multi-vessel disease groups.Compared to the single-vessel disease group,patients in the multi-vessel disease group were older,prevalence of male gender,body mass index,obese and overweight patients,and total cholesterol and low-density lipoprotein cholesterol level,family history of coronary heart disease and percent of impaired glucose regulation and diabetes were all significantly higher(all P<0.05).Logistic regression analysis showed that age(OR=1.038,95%CI:1.009-1.068),smoking(OR=1.964,95%CI:1.232-3.129),body mass index(OR=1.662,95%CI:1.181-2.338),impaired glucose tolerance(OR=1.039,95%CI:1.032-1.224),diabetes(OR=1.651,95%CI:1.032-3.109),and family history of coronary heart disease(OR=2.122,95%CI:1.104-4.076)were risk factors for multi-vessel disease.Conclusions:Proportion of abnormal glucose metabolism is high in coronary heart disease with fasting blood glucose below 7.0 mmol/L and proportion of abnormal glucose metabolism is higher in multi-vessel disease group than in single-vessel disease group in this cohort.