糖调节受损对冠心病患者早期诊断及预后的价值

发布时间：2018-07-14 22:03

【摘要】：目的探讨糖调节受损对冠心病患者早期诊断及预后的价值。方法选择我院2011年心内科明确诊断为冠心病并进行选择性冠脉造影检查的住院患者521例作为CHD组,经有关检查排除CHD的门诊患者200例作为对照组,除已确诊糖尿病的121例CHD患者外,其余研究对象均测定空腹血糖(FBG)及OGTT 2h血糖(2h-PG),同时测定血脂水平并记录相关病史。比较IGR在冠心病组与对照组的发生情况,并对导致IGR的危险因素进行多元Logistic回归分析;根据FBG及2h-PG结果将CHD组分为三个亚组:血糖正常组(NGT组)138例、糖调节受损组(IGR组)168例,糖尿病组(DM组)215例,比较三组患者冠脉病变特点的异同。对所有研究对象进行随访,平均随访时间3.5年,观察患者MACCE事件(非致死性卒中、非致死性心肌梗死、心衰、再介入、全因死亡)的发生情况。结果(1)CHD组患者中糖代谢异常的发生率为73.5%,其中IGR为32.2%、DM为41.3%,IGR的发生率明显高于对照组(21.5%),差异具有显著性(x2=0.062,P=0.005);(2)521例CHD患者中262例均为入院后新发现的糖代谢异常患者,其中168例IGR患者中空腹血糖受损(IFG)为54例、糖耐量异常(IGT)114例,新发现的94例DM患者中空腹高血糖(IFH)11例、餐后高血糖(IPH)83例。(3)DM组与IGR组患者的年龄、BMI、血脂水平及合并有高血压病、早发缺血性心血管病家族史的人数显著高于血糖正常组(P0.01),而DM组与IGR组水平相当(P0.05);(4)多因素回归分析表明,年龄、高血压病史、甘油三酯、胆固醇、高密度脂蛋白胆固醇水平均是IGR的危险因素;(5)餐后2h血糖、甘油三酯水平、年龄、BMI及吸烟史、早发缺血性心血管病家族史均是CHD的危险因素,且餐后2h血糖是CHD的独立危险因素;(6)DM组与IGR组冠心病患者冠脉单支病变发生率低于血糖正常组,而双支、三支病变发生率明显高于血糖正常组,均具有显著性差异(P0.05),而DM组与IGR组比较,无显著性差异(P0.05);(7)平均3.5年的随访中,DM组与IGR组MACCE事件发生率显著高于血糖正常组,差异具有显著性(P0.05),而DM组与IGR组比较,无显著性差异(P0.05);(8)除外215例DM患者,将其余研究对象分为IGR(+)组及IGR(-)组,在平均3.5年的随访中,IGR(+)组患者的MACCE事件发生率显著高于IGR(-)组(P0.01)。结论冠心病患者多伴发糖调节受损,其发生糖尿病的风险增加,且对冠状动脉的损害与糖尿病相近,不仅会加重冠脉病变,同时与不良心血管事件的发生情况密切相关,影响患者预后。早期发现糖代谢异常患者具有重要的临床意义。
[Abstract]:Objective to investigate the value of impaired glucose regulation in early diagnosis and prognosis of coronary heart disease. Methods 521 inpatients who were diagnosed as coronary heart disease and underwent selective coronary angiography in our hospital in 2011 were selected as CHD group and 200 outpatients excluded from CHD as control group. Fasting blood glucose (FBG) and OGTT 2 h blood glucose (2h-PG) were measured in 121 patients with CHD. To compare the occurrence of IGR in CHD group and control group, and to analyze the risk factors of IGR by multivariate logistic regression analysis, according to the results of FBG and 2h-PG, the CHD group was divided into three subgroups: 138 cases in normal blood glucose group (NGT group) and 168 cases in impaired glucose regulation group (IGR group). Two hundred and fifteen patients with diabetes mellitus (DM) were compared with each other in the characteristics of coronary artery disease. All subjects were followed up for an average of 3.5 years to observe the occurrence of MACCE events (non-fatal stroke, non-fatal myocardial infarction, heart failure, re-intervention, all-cause death). Results (1) the incidence of abnormal glucose metabolism in CHD group was 73.5, and the incidence of IGR was 32.2% and 41.3% higher than that in control group (21.5%). The difference was significant (x2n0.062P0. 005); (2). Among 521 CHD patients, 262 were newly found abnormal glucose metabolism. Of 168 IGR patients, 54 were impaired fasting blood glucose (IFG), 114 were impaired glucose tolerance (IGT), 11 were fasting hyperglycemia (IFH) and 83 were postprandial hyperglycemia (IPH). The family history of premature ischemic cardiovascular disease was significantly higher than that of normal blood glucose group (P0.01), while the levels of DM and IGR4 were similar (P0.05); (4) multivariate regression analysis showed that age, history of hypertension, triglyceride, cholesterol, (5) 2h postprandial blood glucose, triglyceride level, age, BMI and smoking history, family history of early ischemic cardiovascular disease were all risk factors of CHD. 2 h postprandial blood glucose was an independent risk factor for CHD. (6) the incidence of coronary artery disease in DM and IGR groups was lower than that in normal glucose group, while the incidence of two-vessel and three-vessel lesion was significantly higher than that in normal glucose group. There was no significant difference (P0.05) between DM group and IGR group, but there was no significant difference (P0.05) between DM group and IGR group (P0.05). The incidence of MACCE in DM group and IGR group was significantly higher than that in normal blood glucose group (P0.05), but there was no significant difference between DM group and IGR group (P0.05), but there was no significant difference between DM group and IGR group in the incidence of MACCE in DM group and IGR group (P0.05). There was no significant difference (P0.05); (8) except 215 patients with DM. The other subjects were divided into IGR- group and IGR- group. The incidence of MACCE in IGR- group was significantly higher than that in IGR- group during an average follow-up of 3.5 years (P0.01). Conclusion the risk of diabetes is increased in patients with coronary heart disease with impaired glucose regulation, and the damage to coronary artery is similar to that of diabetes, which will not only aggravate coronary artery disease, but also be closely related to the occurrence of adverse cardiovascular events. Affect the prognosis of patients. Early detection of abnormal glucose metabolism has important clinical significance.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.2;R541.4

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