冠心病患者糖代谢异常调查分析

目的分析不同糖代谢水平冠心病患者的冠状动脉病变特征,探讨对冠心病患者尽早发现和干预糖代谢异常的重要性。方法 2011年6月—2011年12月在我院心内科住院经冠状动脉造影确诊的冠心病患者385例,均在入院后进行葡萄糖耐量试验,观察患者的糖代谢状况,分析患者的冠状动脉病变特征与不同糖代谢水平的关系。结果 385例患者中63.38%合并糖代谢异常。合并糖代谢异常冠心病患者冠状动脉多支病变(二支及三支)和弥漫性病变的发生率、血管狭窄指数积分均高于糖代谢正常组,冠状动脉单支病变及局限狭窄病变发生率明显低于糖代谢正常组,差异均有统计学意义(P<0.05)。结论冠心病患者糖代谢异常发生率高,合并糖代谢异常的冠心病患者冠状动脉病变严重,表现为多支及弥漫性病变。对心血管患者应关注其血糖代谢,进行葡萄糖耐量试验可以早期发现糖代谢异常患者,有利于冠心病的早期预防,改善患者的预后。     

冠心病合并糖代谢异常患者的临床研究

目的分析冠心病合并糖代谢异常患者的冠状动脉病变特点和糖代谢异常对经皮冠状动脉介入治疗(PCI)操作及住院期不良事件的影响。方法对184例糖代谢异常及147例糖代谢正常的冠心病患者进行回顾性分析。分析患者的冠状动脉病变特点,计算血管造影成功率、操作成功率以及临床成功率,分析糖代谢异常对住院期临床事件的影响。结果糖代谢异常组患者多支病变检出率明显高于糖代谢正常组患者,冠状动脉病变范围更广泛、程度更重、病变更复杂,更易累及小血管(P<0.05)。糖代谢异常组与糖代谢正常组之间的血管造影成功率、操作成功率和临床成功率差异无统计学意义(分别为91.8%vs.93.9%,88.0%vs.91.8%及85.3%vs.90.5%,P均>0.05)。Logistic多元回归分析显示糖代谢异常不是PCI术住院期发生不良事件的独立危险因素(OR=0.999,95%IC:0.242~9.172,P>0.05)。结论糖代谢异常患者冠状动脉病变比糖代谢正常患者更复杂、严重;糖代谢异常不是PCI术住院期发生不良事件的独立危险因素。     

冠心病和高血压住院患者糖代谢异常分析

目的:了解冠心病、高血压住院患者糖代谢异常的状况.方法:对符合冠心病、高血压诊断标准的心内科住院患者连续入选,共497例进行葡萄糖耐量试验.结果:总的糖代谢异常率60.6%.糖尿病患病率为24.4%,糖调节受损患病率为36.2%.糖调节受损中绝大多数(96.1%)为单纯糖耐量受损.冠心病伴高血压时,糖代谢异常发生率明显高于单纯高血压、单纯冠心病.结论:冠心病、高血压住院患者半数以上并发糖代谢异常,两病并存时糖代谢异常明显升高.     

中国住院冠心病患者糖代谢异常研究--中国心脏调查

目的 探讨中国冠心病患者糖代谢异常的流行状况。方法 选取北京、上海等7个城市共52家三级甲等医院为合作研究中心，于2005年6月1日至2005年9月31日在各医院心内科所有符合冠心病诊断纳入标准的住院患者连续入选为研究对象，共收集有效病例3513例。未确诊为糖尿病的对象均需进行口服葡萄糖耐量试验（OGTT），以判断糖代谢状况。结果 冠心病住院患者中糖尿病患病率为52．9％，糖调节受损患病率为24．0％，总的糖代谢异常患病率为76．9％。若不进行OGTT试验，仅依靠检测空腹血糖，将有87．4％糖调节异常患者和80．5％糖尿病患者被漏诊。结论 中国冠心病住院患者中绝大多数合并糖代谢异常，并且需要通过OGTT及时准确地发现这些合并糖代谢异常的患者。     

冠心病与糖代谢异常的关系

目的:探讨冠心病与糖代谢异常的关系。方法:对本院心血管内科住院的512例冠心病患者进行糖耐量试验和冠脉造影检查,统计糖耐量异常患者比例,对比不同糖耐量患者之间的冠脉病变程度。结果:除已确诊为糖尿病的166例患者外,余下接受口服葡糖耐量试验(OGTT)的346例患者中,新发糖尿病74例(21.39%),糖调节异常152例(43.93%)。512例冠心病患者中,糖尿病患者240例,高达46.88%。空腹血糖(FPG)与OGTT试验结果对比,单纯检测FPG糖尿病漏诊率为43.2%,糖调节异常漏诊率为73.7%;与糖耐量正常和糖耐量异常组比较,糖尿病组冠脉病变3支及以上病变比例明显升高(20.83%比30.92%比58.75%),P0.05~0.01。结论:冠心病大多数合并有糖代谢异常,糖尿病组冠脉病变3支及以上病变比例明显高于糖耐量正常和糖耐量异常组;口服葡萄糖耐量试验能显著提高糖代谢异常的检出率。     

冠心病患者的糖代谢异常分析

目的探讨冠心病患者血糖代谢异常的发生率以及糖代谢异常对心血管事件发生和影响预后的可能机制。方法选择病情稳定的冠心病(NACS)患者和急性冠脉综合征(ACS)患者各110例。抽取静脉血检查空腹血糖(FBG)和餐后2小时血糖(2hPG),若其中任何1项异常,则进行口服葡萄糖耐量试验(OGTT)。根据血糖结果分为糖代谢正常组和糖代谢异常组(包括糖耐量异常组和糖尿病组)。同时行丙二醛(MDA)和超氧化物歧化酶(SOD)测定。结果糖代谢异常发生率在NACS和ACS患者中分别占44.54%和63.64%。无论NACS患者或ACS患者,糖代谢异常组的MDA升高和SOD降低与糖代谢正常组比较差异均有显著性;合并糖尿病和合并糖耐量异常的患者组间MDA及SOD水平比较,差异无显著性。结论糖代谢异常在冠心病患者中发生率较高,其中新识别糖代谢异常需要行OGTT检查;合并糖代谢异常的冠心病患者脂质过氧化程度高;合并糖耐量异常与合并糖尿病一样,对冠心病患者有相等程度的氧化应激。     

糖代谢异常与心血管疾病关系的再认识

2005年6月至9月中国心脏调查研究组在中国中心城市的三级甲等医院的心血管专科,对住院冠心病患者的糖代谢异常流行病学情况进行了调查,并于2006年2月发表了“中国住院冠心病患者糖代谢异常研究”的报告。报告显示,中国冠心病住院患者中约3/4合并糖代谢异常,甚至超过了西方国家调查研究得出的2/3的比例。因此,进一步了解糖代谢异常与心血管疾病的关系,认识到早期诊治糖代谢异常对全面防治心血管疾病、改善心血管预后的意义至关重要。1糖代谢异常与心血管疾病的相关性1.1糖尿病及糖尿病前期的糖代谢异常均与心血管疾病密切相关糖尿病与心血管…     

重视老年高血压患者早期的糖代谢异常

欧洲心脏调查结果表明,高达三分之二的冠心病患者合并高血糖.中国心脏调查显示冠心病合并高血糖的比例已高达80%,而在冠心病患者中60%患有高血压,年龄≥60岁的达70%.高血压合并糖代谢异常者据统计已＞60%,而老年人所占比例更高,这些患者具有较高的心脑血管事件发生比例.2007年全球成年人糖尿病的患病人数已达2.46亿,而葡萄糖耐量异常(IGT)的患病人数则高达3.08亿.有研究表明,我国的IGT人数已超过6000万,位居世界首位.流行病学研究结果显示,从正常糖代谢到糖调节异常(IGR)再到糖尿病,心血管疾病的风险逐渐加强.     

冠心病患者糖代谢异常调查分析

糖尿病患者冠心病的患病率是其他患者的2～3倍,心血管死亡率是其他患者的3倍,在校正了其他危险因素之后,糖尿病仍是冠心病预后不良的独立的危险因素。我们对心内科住院的冠心病患者糖代谢异常的诊治状况进行分析,以促进心内科医生对冠心病合并糖代谢异常患者的重视。     

心血管疾病与糖调节异常(3)心血管疾病中常见血糖代谢异常的诊断(续2)

约有四分之三的住院冠心病患者合并糖代谢异常。糖代谢异常包括空腹血糖受损、糖耐量受损和糖尿病。心血管急症患者往往合并应激性高血糖,检测糖化血红蛋白(HbA1c)有助于鉴别应激性高血糖与糖尿病。控制高血糖有利于改善心血管疾病患者的预后。     

心力衰竭患者血糖升高的临床意义探讨

目的探讨非糖尿病心脏病合并心力衰竭患者入院时空腹血糖浓度升高的临床意义。方法选择非糖尿病冠状动脉粥样硬化性心脏病（冠心病）、高血压心脏病合并心力衰竭患者392例为研究对象。入院时常规测入选患者的空腹血糖浓度,比较不同血糖浓度组患者的心功能分级和住院病死率。结果在这392例心力衰竭患者中,血糖浓度正常者达162例（41.3%）,糖调节受损122例（29.4%）,高血糖108例（26.0%）。高血糖组心功能Ⅲ～Ⅳ级患者占76.9%,糖调节受损组占65.6%,与血糖正常组（22.8%）比较,差异有统计学意义（P〈0.05）。在院内死亡的17例中,血糖正常组2例（11.8%）,糖调节受损组6例（35.3%）,高血糖组9例（52.9%）;3组住院病死率比较,差异有统计学意义（P〈0.05）。结论非糖尿病心脏病合并心力衰竭患者血糖越高,心力衰竭严重程度越高,住院病死率也越高,提示糖代谢紊乱可能是心力衰竭的发生、发展及预后的影响因素。     

Misclassification of diabetic subjects may account for the increased vascular risk of impaired glucose tolerance: the Islington Diabetes Survey.

We have studied the associations of macrovascular disease and hypertension with impaired glucose tolerance in a recall sample of 223 subjects selected from a population aged greater than or equal to 40 years who had been screened for diabetes using two separate glucose tolerance tests. Blood pressure was higher in subjects with diabetes, but not in those with impaired glucose tolerance, than in normals. Coronary heart disease, based on ECG criteria and history, was more frequent both in subjects with impaired glucose tolerance (odds ratio 1.94, 95% CI 1.02-3.69) and those with diabetes (odds ratio 3.88, 95% CI 1.33-11.97) than in normals, but the excess in the impaired glucose tolerance group was reduced, and was no longer significant, when adjusted for other variables (odds ratio 1.29, 95% CI 0.62-2.66). Peripheral vascular disease was more frequent in subjects with diabetes, but not in those with impaired glucose tolerance. When the subjects with impaired glucose tolerance on a single test were reclassified according to the results of a separate glucose tolerance test, the prevalence of coronary heart disease increased significantly with increasing degrees of glucose intolerance. Subjects with impaired glucose tolerance on both tests had an adjusted odds ratio of coronary heart disease of 0.90 (95% CI 0.42-1.94) compared with normal subjects. The excess of macrovascular disease in subjects with impaired glucose tolerance may result, at least in part, from the admixture of 'false negative diabetics' in that class.     

Association of plasma triglyceride and C-peptide with coronary heart disease in Japanese-American men with a high prevalence of glucose intolerance

Summary In a community-based study of second-generation Japanese-American men known to have a high prevalence of both Type 2 (non-insulin-dependent) diabetes and impaired glucose tolerance, there was a highly significant association of coronary heart disease with glucose intolerance in a study sample of 219 men. Intra-abdominal cross sectional fat area determined by computed tomography was significantly elevated in men with coronary heart disease even after adjustment for glucose intolerance and body mass index (p=0.026). Other differences that were significantly related to coronary heart disease after adjustment for glucose intolerance were lower high density lipoprotein cholesterol levels (p=0.001), elevated total triglyceride and very low density lipoprotein triglyceride (p<0.001), and elevated fasting insulin and C-peptide levels p=0.001. When these variables were tested in a stepwise multiple logistic regression model, significant independent associations with coronary heart disease were found only for total triglyceride and fasting C-peptide after adjustment for glucose tolerance status. Variables identified to be associated with coronary heart disease were interpreted as representing or manifesting an insulin resistant state. Thus, insulin resistance may be the underlying risk factor aetiologically linking glucose intolerance with coronary heart disease.     

Diabetes mellitus in Swedish middle-aged men

Summary As part of a study of the epidemiology of diabetes mellitus in middle-aged Swedish men, the present paper reports the prevalence and incidence of diabetes and the prevalence of impaired glucose tolerance. Two cohorts of 50-year-old men, representative of the corresponding male population of Gothenburg, Sweden, were examined in 1963 and 1973, respectively, and then followed until 1980. In the cohort of men born in 1913 (n=855) the diabetes prevalence (WHO criteria), based on a questionnaire and fasting blood glucose, increased from 1.5% at age 50 to 7.6% at age 67. In the cohort of men born in 1923 (n=226) the prevalence was 3.7% at age 50 and 4.0% at age 57. The overall prevalence of diabetes and impaired glucose tolerance was 25% among men born in 1913 (age 67) and 18% among men born in 1923 (age 57). The cumulative risk of developing diabetes from age 50 to 67 was 7.8%. Variables associated with impaired glucose tolerance and newly found diabetes, when degree of obesity was considered, were systolic blood pressure and triglycerides, well known risk factors for both coronary heart disease and diabetes. Uric acid, fasting insulin and glutamic puruvic transaminase, recently discussed as possible risk factors, were also associated with impaired glucose tolerance and newly found diabetes. Thus, both impaired glucose tolerance and newly found diabetes were associated with a clustering of risk factors, not only for diabetes but also for coronary heart disease.     

A comparison of the relationships of the glucose tolerance test and the glycated haemoglobin assay with diabetic vascular disease in the community. The Islington Diabetes Survey.

We have compared the relationships of fasting and 2 h blood-glucose during a 75 g oral glucose tolerance test, and those of an affinity chromatography assay of glycated haemoglobin, with the presence of vascular complications of diabetes mellitus in 223 subjects without known diabetes aged over 40 years selected from a community screening study population. The subjects included 15 (6.9%) with newly diagnosed diabetes and 52 (24.1%) with impaired glucose tolerance. Employing receiver operating characteristic analysis, the tests were similar in their relationship with three cases of retinopathy, 19 of microalbuminuria and six of peripheral neuropathy. The prevalence of coronary heart disease, defined as angina, myocardial infarction, or electrocardiographic changes of ischaemia, increased linearly across all four quartiles of both 2 h blood glucose and glycated haemoglobin concentration, but using logistic regression analysis, 2 h blood glucose was a better predictor of coronary heart disease than glycated haemoglobin. Receiver operating characteristic analysis also showed that 2 h blood glucose generally performed better than any of four assays of glycated haemoglobin in classifying those subjects with coronary heart disease.     

Prevalence of impaired glucose tolerance in ischemic Egyptian patients

Background and aimPrediabetes (impaired glucose tolerance or impaired fasting glucose) is usually associated with a higher health risk profile for cardiovascular diseases. To our knowledge, no data about its prevalence in Egyptian patients are available. We aimed to determine the prevalence of prediabetes among Egyptian patients who were known to be neither diabetic nor prediabetic & referred to undergo coronary angiography.Methods and resultsThe study included 1000 consecutive Egyptians in the Cairo governorate with no previous diagnosis of diabetes nor prediabetes, who underwent coronary angiography for suspected coronary artery disease. They were screened for having prediabetes with either impaired fasting glucose through checking their fasting blood sugar or impaired glucose tolerance through checking their 2 h postprandial blood sugar.Twenty-three percent of patients had prediabetes; either isolated impaired fasting glucose, isolated impaired glucose tolerance or both combined together. The mean age of all patients was 52.35 ± 7.02 years. 26.33% of female patients were prediabetic while 21.43% of male patients were prediabetic. Hypertensive prediabetic patients numbered 110 and most of them were females. Body Mass Index among prediabetic patients was higher than that among patients with normal glucose tolerance and in females more than males. Prediabetes was more prevalent among patients with acute coronary syndrome than among patients with chronic ischemic heart disease.ConclusionPrediabetes is prevalent among ischemic Egyptian patients at a considerable ratio and should be screened for.     

Glucose tolerance, serum insulin and lipid abnormalities in patients with coronary heart disease.

Blood glucose, free fatty acid and insulin responses to oral glucose and the fasting serum lipids were measured in 3 groups: 32 non-obese (mean age: 47.5 years) and 9 obese (mean age: 84.5 years), male patients with coronary heart disease and 12 non-obese male controls (mean age: 46.5 years). The oral glucose tolerance tests were repeated after 3 years in 16 of the non-obese patients with coronary heart disease. The results were as follows: 1) Glucose tolerance was impaired in 19 of 32 non-obese patients (59.4%). There was a significant correlation between impaired glucose tolerance and hyperlipidemia (hypercholesterolemia and/or hypertriglyceridemia). 2) In obese patients FFA levels at 30, 60, and 120 min after oral glucose administration were significantly elevated and FFA decrease was delayed with a drop to minimum levels at 180 min. 3) The insulin response after oral glucose administration in the group of non-obese patients with normal glucose tolerance was similar to that of non-obese controls. In the group of non-obese patients with impaired glucose tolerance, serum insulin levels went up to normal levels, but the peak was delayed. The serum insulin levels in obese patients were significantly higher than those of controls of 0, 60, 120, and 180 min. After 3 years the change in insulin response to oral glucose was not related to anginal symptoms or ECG findings, but was related to body weight change in patients with minor changes in glucose tolerance. 4) The metabolic pattern in the non-obese group with impaired glucose tolerance resembled that of "mild diabetes" in delayed response of insulin and FFA, and mild hyperlipidemia. These findings suggest that obesity may contribute to hyperinsulinemia in patients with coronary heart disease and that impaired glucose tolerance observed in patients with coronary heart disease is in part due to "latent diabetes".     

老年糖耐量减退患者血尿酸水平与冠心病相关性研究

目的探讨老年糖耐量减退患者血尿酸水平与冠心病的关系。方法选取糖耐量减退患者118例,根据冠状动脉造影结果分为单纯糖耐量减退组(51例)及糖耐量减退合并冠心病组(67例),测定两组患者的血尿酸、血脂等生化指标,分析血尿酸水平与糖耐量减退合并冠心病的相关性。结果糖耐量减退合并冠心病组血尿酸水平为(354.92±51.27)μmol/L,单纯糖耐量减退组血尿酸水平为(323.57±48.66)μmol/L,两组比较差异有统计学意义(P<0.01),其中单支、双支、三支病变患者血尿酸水平分别为(330.92±53.65)μmol/L(、347.25±56.17)μmol/L、(362.93±54.21)μmol/L,各组间比较差异无统计学意义(P>0.05)。血尿酸水平与冠状动脉病变程度呈正相关(r=0.24,P<0.05)。结论老年糖耐量减退合并冠心病患者冠状动脉病变程度与血尿酸相关,测定血尿酸水平可对此类患者冠状动脉病变程度提供参考依据。     

Hyperinsulinaemia is not a major coronary risk factor in elderly men

Summary Insulin and insulin resistance have attracted considerable interest as possible risk factors for coronary heart disease during the last decade. We therefore examined the 8 year incidence of coronary heart disease in 595 67-year-old men in relation to baseline insulin and other risk factors. The incidence of coronary heart disease increased from 9% among non-diabetic men to 13.5% among those with impaired glucose tolerance, 12.9% among newly-detected diabetic men and up to 31.3% among men with known diabetes. The incidence of coronary heart disease was related to fasting blood glucose and 1 h and 2 h blood glucose during the oral glucose tolerance test and to serum cholesterol and serum triglycerides. Fasting serum insulin was of borderline significance for the risk of coronary heart disease. When known diabetic subjects were excluded only serum cholesterol and serum triglycerides remained as statistically significant risk factors. Among diabetic subjects (known and newly-detected) only blood glucose was related to the risk of coronary heart disease. In multivariate analyses the different degrees of glucose intolerance or fasting blood glucose were independently related to the risk of coronary heart disease (p=0.008–0.010). Serum triglycerides were also an independent risk factor in three out of four multivariate models (p=0.02–0.09). Fasting serum insulin was not an independent risk factor. These findings do not support the hypothesis that hyperinsulinaemia is a major risk factor for coronary heart disease in elderly men. Hyperglycaemia (or diabetes mellitus) seems to be the most important risk factor.     

糖代谢异常患者肾功能状态对冠脉病变程度的影响

目的探讨糖代谢异常人群中估算的肾小球滤过率（eGFR）对冠脉病变范围及严重程度的影响。方法采用简化的肾脏疾病饮食改良公式（MDRD）计算eGFR,比较不同MDRD-eGFR组在临床生化指标、狭窄冠状动脉支数、冠状动脉狭窄严重程度积分等方面的差别。结果糖调节受损组、糖尿病组及总体人群中,狭窄冠脉支数、Gensini积分与MDRD—eGFR均呈负相关性（P〈0．05）,与肌酐均呈正相关性（P〈0．05）。MDRD-eGFR〈60mL·mm-1·（1．73m2）-1 组狭窄冠脉支数多于60～89mL·min-1·（1．73m2）-1组及≥90mL·min。-1·（1．73m2）-1组,Gemini积分也高于其余两组（均P〈0．05）。校正年龄、空腹血糖、糖化血红蛋白、尿素氮、肌酐及尿酸因素后,狭窄冠脉支数、Gensini积分与MDRD—eGFR之间均呈负相关性,偏相关系数分别为-0．051和-0．022（P〈0．05）。Logistic逐步回归分析显示MDRD—eGFR为发生3支及以上冠脉病变的独立危险因素。结论糖代谢异常人群具有较高的冠心病患病率,肾小球滤过率的下降与冠脉病变程度具有一定的负相关性,且为发生多支冠脉病变（≥3支）的独立危险因素。