高血压患者发生急性心肌梗死时不同血糖水平与冠状动脉病变严重程度的关系

Relationship between blood glucose levels and severity of coronary artery lesion in hypertension patients suffering acute myocardial infarction

目的探讨高血压患者发生急性心肌梗死(AMI)时不同严重程度冠状动脉血管病变与糖化血红蛋白(HbA1c)水平的关系,探讨不同血糖水平分层高血压患者发生冠状动脉严重病变的相关影响因素。方法连续入选2018年7月至2019年1月经首都医科大学附属北京安贞医院急诊科收住入院的合并高血压的AMI患者277例,采用Gensini评分评估全部患者冠状动脉血管病变严重程度。将患者分为冠状动脉血管轻中度病变者(对照组,Gensini评分<41分,136例)和冠状动脉血管严重病变者(观察组,Gensini评分≥41分,141例)。比较2组间各项临床指标以及冠状动脉造影检查结果。采用Logistic回归方法分析不同血糖水平高血压患者并发AMI时严重冠状动脉病变的危险因素。结果观察组HbA1c水平、冠状动脉血管病变支数和Gensini评分明显高于对照组[(7.1±1.8)%比(6.3±1.1)%、(2.1±0.7)支比(1.5±0.7)支、(73±28)分比(23±10)分](均P<0.05)。合并高血压的AMI患者HbA1c水平与冠状动脉病变血管Gensini评分呈正相关(r=0.618,P<0.001)。在全部研究对象中,HbA1c≥7.0%、合并心血管疾病是高血压患者发生AMI时严重冠状动脉病变的重要危险因素(比值比=3.318、3.908,95%置信区间:1.355~8.127、1.088~15.188,P=0.009、0.042)。在HbA1c≥7.0%的研究对象中,HbA1c水平升高、年龄增加和总胆固醇水平升高是高血压患者发生AMI时严重冠状动脉病变的重要危险因素(比值比=4.306、1.650、3.395,95%置信区间:1.343~15.164、0.679~2.402、1.707~8.684,P=0.039、0.042、0.026)。而在HbA1c<7.0%的研究对象中,e GFR水平降低、LDL-C水平升高是高血压患者发生AMI时严重冠状动脉病变的重要危险因素(比值比=1.486、3.475,95%置信区间:1.045~3.791、1.831~18.665,P=0.015、0.011)。结论不同血糖水平高血压患者并发AMI时冠状动脉病变严重程度影响因素不同。在HbA1c≥7.0%的高血压患者中,HbA1c水平升高是高血压患者发生AMI时冠状动脉严重病变的重要危险因素。

Objective To investigate the relationship between the severity of coronary vascular lesion and levels of glycosylated hemoglobin(Hb A1 c)in hypertension patients suffering acute myocardial infarction(AMI)and to explore the related influencing factors of the serious coronary artery lesion in hypertensive patients with different blood glucose levels.Methods A total of 277 AMI patients with hypertension admitted to Department of Emergency,Beijing Anzhen Hospital,Capital Medical University from July 2018 to January 2019 were enrolled.Gensini score was used to evaluate the severity of coronary artery lesion in all patients.The patients were divided into mild to moderate coronary artery lesion(control group,Gensini score<41,136 cases)and severe coronary artery lesion(observation group,Gensini score≥41,141 cases).The clinical indexes and coronary angiography results were compared between the two groups.Logistic regression method was used to analyze the risk factors of severe coronary artery lesion in hypertension patients suffering AMI with different blood glucose levels.Results HbA1c level,the number of coronary artery lesion and Gensini score in the observation group were significantly higher than those in the control group[(7.1±1.8)%vs(6.3±1.1)%,(2.1±0.7)vs(1.5±0.7),(73±28)vs(23±10)](all P<0.05).There was a positive correlation between HbA1c level and coronary artery lesion Gensini score in AMI patients with hypertension(r=0.618,P<0.001).In all subjects,HbA1c≥7.0%and complicated with cardiovascular disease were the important risk factors of severe coronary artery lesion in hypertension patients suffering AMI(odds ratio=3.318,3.908,95%confidence interval:1.355-8.127,1.088-15.188,P=0.009,0.042).Among the subjects with HbA1c≥7.0%,the increase of HbA1c level,age and total cholesterol level were the important risk factors of severe coronary artery lesion in hypertensive patients suffering AMI(odds ratio=4.306,1.650,3.395,95%confidence interval:1.343-15.164,0.679-2.402,1.707-8.684,P=0.039,0.042,0.026).Among the subjects with HbA1c<7.0%,the decrease of estimated glomerular filtration rate level and the increase of low-density lipoprotein cholesterol level were the important risk factors of severe coronary artery lesion in hypertensive patients suffering AMI(odds ratio=1.486,3.475,95%confidence interval:1.045-3.791,1.831-18.665,P=0.015,0.011).Conclusions In hypertension patients suffering AMI,the influencing factors of the severity of coronary artery lesion in different blood glucose levels are different.In hypertension patients with HbA1c≥7.0%,the increase of HbA1c level is an important risk factor of severe coronary artery lesion in hypertension patients suffering AMI.