2型糖尿病患者葡萄糖目标范围内时间与冠状动脉病变严重程度的相关性研究

Association of time in range with the severity of coronary artery disease in type 2 diabetic patients

目的探讨2型糖尿病合并冠心病患者葡萄糖目标范围内时间(TIR)与冠状动脉病变严重程度及急性冠脉综合征发生风险的相关性。方法本研究纳入216例2型糖尿病合并冠心病患者作为研究对象,进行临床资料收集、血样检验、持续葡萄糖监测、SYNTAX评分计算等,TIR是指24 h内葡萄糖在目标范围内(通常为3.9~10.0 mmol/L)时间所占的百分比。采用Spearman相关性分析及多元线性回归分析评估SYNTAX评分的相关性因素,采用logistic回归分析评估TIR与冠状动脉病变严重程度、急性冠脉综合征发生风险的相关性。结果中重度冠状动脉病变患者较轻度冠状动脉病变患者TIR[(60.8±17.8)%比(69.4±17.3)%]更低(t=3.0,P=0.003)、HbA_(1C)[(9.6±1.7)%对(8.8±1.6)%]更高(t=3.3,P=0.001);Spearman相关性分析显示SYNTAX积分与TIR呈负相关(r=-0.251,P<0.01),与HbA_(1C)呈正相关(r=0.249,P<0.01);多元线性回归分析显示TIR、HbA_(1C)、糖尿病病程、吸烟均与SYNTAX积分具有独立的相关关系,且与HbA_(1C)(标准化回归系数=0.181,P=0.007)相比,TIR(标准化回归系数=-0.192,P=0.004)对SYNTAX积分的影响更大;多因素logistic回归分析显示,与TIR Q1组相比,TIR Q3组、TIR Q4组是中重度冠状动脉病变(分别为OR=0.61和0.59,95%CI 0.39~0.96和0.38~0.94,P=0.014和0.009)及急性冠脉综合征(分别为OR=0.51和0.39,95%CI 0.32~0.95和0.26~0.75,P=0.022和0.008)的独立保护因素。结论控制HbA_(1C)等混杂因素后,2型糖尿病合并冠心病患者TIR与冠状动脉病变严重程度及急性冠脉综合征发生风险存在显著的独立相关性,TIR水平越低,SYNTAX评分越高,冠状动脉病变程度越重,发生急性冠脉综合征风险越高。

Objective To investigate the association of time in range(TIR)with the severity of coronary artery disease and acute coronary syndrome in patients with type 2 diabetes mellitus.Methods A total of 216 patients with type 2 diabetes mellitus and coronary heart disease were recruited and undergone anthropometric and biochemical measurements,continuous glucose monitoring,and calculation of SYNTAX score.TIR was defined as the percentage of time within the glucose range of 3.9-10.0 mmol/L during 24 h.Spearman correlation analysis and multivariate linear regression analysis were used to evaluate the correlation factors of SYNTAX score.Multivariate logistic regression analysis was used to analyze the association of TIR with the severity of coronary artery disease and acute coronary syndrome.Results Compared with patients with mild coronary artery disease,TIR in patients with moderate to severe coronary artery disease was lower[(69.4±17.3)%vs(60.8±17.8)%,t=3.0,P=0.003],and HbA_(1C) of patients with moderate to severe coronary artery disease was higher[(9.6±1.7)%vs(8.8±1.6)%,t=3.3,P=0.001].SYNTAX score was negatively correlated with TIR(r=-0.251,P<0.01)and positively correlated with HbA_(1C)(r=0.249,P<0.01).Moreover,compared with HbA_(1C)(standardized coefficients=0.181,P=0.007),TIR(standardized coefficients=-0.192,P=0.004)had a greater influence on SYNTAX score.Multivariate linear regression analysis showed that TIR,HbA_(1C),duration of diabetes and smoking were independently correlated with SYNTAX score.Multivariate logistic regression analysis revealed that compared with TIR Q1,Q3 and Q4 were independent protective factors for moderate to severe coronary artery disease(respectively,OR=0.61 and 0.59,95%CI 0.39-0.96 and 0.38-0.94,P=0.014 and 0.009)and acute coronary syndrome(respectively,OR=0.51 and 0.39,95%CI 0.32-0.95 and 0.26-0.75,P=0.022 and 0.008).Conclusion TIR was significantly and independently correlated with the severity of coronary artery disease and acute coronary syndrome in type 2 diabetes mellitus after controlling confounding factors.When TIR level was decreased,the severity of coronary artery disease was aggravated,and SYNTAX score and the risk of acute coronary syndrome was increased.