长期空腹血糖变异性与老年男性冠心病患者冠脉病变程度关系初探

Correlation between long-term fasting blood glucose variability and severity of coronary artery lesions in elderly male patients with coronary heart disease

背景既往研究发现,冠脉病变严重程度与短期血糖变异性存在相关性,但其与长期血糖变异性关系的研究相对缺乏。目的探讨长期空腹血糖变异性与老年男性冠心病患者冠脉病变严重程度的关系。方法回顾性纳入2009年8月-2020年10月于解放军总医院第二医学中心接受冠状动脉造影手术的老年(年龄≥60岁)男性患者140例,根据冠状动脉造影结果,将入组患者分为重度病变组(Gensini评分≥30分,n=67)和轻度病变组(Gensini评分<30分,n=73)。采用多因素logistic二元回归分析确定冠脉重度病变的独立危险因素,分析长期空腹血糖标准差(standard deviation of fasting blood glucose,SD_(FBG))、空腹血糖变异系数(coefficient of variation of fasting blood glucose,CV_(FBG))、空腹血糖平均连续变异性(average successive values of fasting blood glucose,ASV_(FBG))与冠脉病变严重程度的关系。结果将SD_(FBG)、CV_(FBG)、ASV_(FBG)作为连续变量分析时,三者均与老年男性冠脉病变严重程度呈正相关[SD_(FBG):HR=2.274(95%CI:1.175~4.401),P=0.015;CV_(FBG):HR=1.057(95%CI:1.005~1.111),P=0.032;ASV_(FBG):HR=1.924(95%CI:1.047~3.536),P=0.035]。将其作为等级变量进行分析时,高、中SD_(FBG)(>0.59 mmol/L、0.35~0.59 mmol/L)患者的冠脉重度病变风险分别是低SD_(FBG)(<0.35 mmol/L)患者的2.631倍(95%CI:1.109~6.241,P=0.028)、2.473倍(95%CI:1.037~5.900,P=0.041);高CV_(FBG)(>10.40%)患者的冠脉重度病变风险是低CV_(FBG)(<6.61%)患者的2.399倍(95%CI:1.019~5.645,P=0.045),中CV_(FBG)(6.61%~10.40%)患者冠脉重度病变风险与低CV_(FBG)患者比较,差异无统计学意义;高、中ASV_(FBG)(>0.61 mmol/L、0.41~0.61 mmol/L)患者的冠脉重度病变风险与低ASV_(FBG)(<0.41 mmol/L)患者比较,差异无统计学意义。结论长期空腹血糖变异性与老年男性冠脉病变严重程度呈正相关。

Background The gold standard for diagnosis of coronary heart disease is coronary angiography(CAG),and previous studies have found that there is a correlation between short-term glycemic variability and severity of coronary artery lesions,while similar research in terms of long-term glycemic variability is rare.Objective To investigate the relationship between long-term fasting blood glucose(FBG)variability and severity of coronary artery lesions in elderly male patients with coronary heart disease(CHD).Methods A total of 140 inpatients underwent CAG in the Second Medical Center of Chinese PLA General Hospital from August 2009 to October 2020 were enrolled and divided into group A(Gensini score≥30 points,n=67)and group B(Gensini score<30 points,n=73)according to their CAG reports.Multivariate logistic binary regression analysis was used to determine the independent risk factors of severe lesions.And the correlation between severity of their coronary artery lesions and long-term FBG variability including the standard deviation,the coefficient of variation and the average successive values was analyzed.Results SDFBG,CVFBG and ASVFBG were all positively correlated with severity of lesions in elderly men with CHD(SDFBG:HR:2.274[95%CI:1.175-4.401],P=0.015;CVFBG:HR:1.057[95%CI:1.005-1.111],P=0.032;ASVFBG:HR:1.924[95%CI:1.047-3.536],P=0.035).When long-term FBG variability was analyzed as a ordinal variable,compared with low SDFBG(<0.35 mmol/L)group,participants with high or median SDFBG(>0.59 mmol/L,0.35-0.59 mmol/L)had a significantly higher risk for severe lesions of coronary artery,which were 2.631 times(95%CI:1.109-6.241,P=0.028)and 2.473 times(95%CI:1.037-5.900,P=0.041),respectively.While the same risk in patients with high CVFBG(>10.40%)was 2.399 times(95%CI:1.019-5.645,P=0.045)compared to low CVFBG(<6.61%)patients.There was no obvious difference between median CVFBG(6.61-10.40%)group and low CVFBG group in terms of severity lesions,the same as risk in high or median ASVFBG(>0.61 mmol/L,0.41-0.61 mmol/L)group compared with low ASVFBG(<0.41mmol/L)group.Conclusion There exists positive correlation between long-term fasting blood glucose variability and severity of coronary artery lesions in elderly male patients with CHD.