2型糖尿病合并冠状动脉粥样硬化性心脏病的临床特征分析

Clinical Characteristics of Type 2 Diabetes Mellitus Complicated with Coronary Atherosclerotic Heart Disease

目的研究2型糖尿病(type 2 diabetes mellitus,T2DM)合并冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CAD)的临床特点。方法纳入2020年1月~2022年12月新疆医科大学第一附属医院收治的T2DM合并CAD患者(病例组)2364例和T2DM患者(对照组)2495例,对患者的一般资料(包括年龄、性别、糖尿病病程、体重指数)、血清糖化血红蛋白(glycosylated hemoglobin,HbA1c)、血脂、脂蛋白a[lipoprotein(a),Lp(a)]、尿酸、甲状腺功能、甲状腺自身免疫抗体、胆红素、胱抑素C(cystatin C,CysC)、同型半胱氨酸(homocysteine,Hcy)水平进行统计学分析。结果病例组患者年龄、收缩压、舒张压、HbA1c、CysC、尿酸、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、促甲状腺激素(thyroid stimulating hormone,TSH)、甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibodies,TPOAb)水平较对照组患者高,差异有统计学意义(P<0.05)。两组男女性别构成比比较,差异有统计学意义(P<0.01)。两组患者糖尿病病程、体重指数、Hcy、TC和TG水平比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,性别、年龄、糖尿病病程、吸烟史、饮酒史、高血压病史、收缩压、血清胆红素3项、血脂4项、Lp(a)、Hcy、CysC、总甲状腺素(total thyroxine,TT_(4))、游离甲状腺素(free thyroxine,FT_(4))、总三碘甲状腺原氨酸(total triiodothyronine,TT_(3))、游离三碘甲状腺原氨酸(free triiodothyronine,FT_(3))、TgAb和TPOAb为T2DM合并冠心病的独立相关因素。结论多种血清学指标与T2DM合并CAD独立相关,对于此类患者,在治疗高血糖和CAD的同时,还需注意其他指标,如CysC、胆红素和甲状腺功能的变化。

Objective To investigate the clinical characteristics of type 2diabetes mellitus(T2DM)complicated with coronary atherosclerotic heart disease(CAD).Methods A total of 2364 patients with T2DM complicated with CAD(case group)and 2495 patients with T2DM(control group)were enrolled in the First Affiliated Hospital of Xinjiang Medical University from January 2020 to December 2022.General information[including age,gender,course of diabetes,body mass inedx(BMI)],serum glycosylated hemoglobin(HbA1c),lipid metabolism level,lipoprotein(a)[Lp(a)],uric acid,thyroid function,thyroid autoimmune antibody,bilirubin,cystatin C(CysC)and homocysteine(Hcy)levels of the patients were statistically analyzed.Results There age,systolic pressure,diastolic pressure,HbA1c,CysC,uric acid,total cholesterol(TC),low density lipoprotein-cholesterol(LDL-C),TSH,TgAb and TPOAb in case group were higher than those in control group,there were statistically significant differences between the two groups(P<0.05).The difference in gender composition between the two groups was statistically significant(P<0.01).There were no significant differences in diabetes course,BMI,Hcy,TC and TG levels between the two groups(P>0.05).The results of multivariate Logistic regression analysis showed that gender,age,course of diabetes,smoking history,drinking history,hypertension history,systolic blood pressure,bilirubin,lipid metabolism level,Lp(a),Hcy,CysC,total thyroxine(TT_(4)),free thyroxine(FT_(4)),total triiodothyronine(TT_(3)),free triiodothyronine(FT_(3)),TgAb and TPOAb were independent correlation factors for T2DM complicated with CAD.Conclusion Multiple serological markers are independently correlated with T2DM complicated with CAD.For these patients,doctors should pay attention to other markers,such as CysC,bilirubin and thyroid function,while treating hyperglycemia and CAD.