2型糖尿病发生冠心病相关危险因素的研究

目的探讨2型糖尿病患者发生冠心病的相关危险因素。方法选择2型糖尿病患者150例,根据是否合并冠心病分为2组,单纯2型糖尿病患者组(A组)82例和2型糖尿病合并冠心病患者组(B组)68例。另选择同期健康体检者60例作为对照组,测定各组的同型半胱氨酸、高敏C反应蛋白、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原和D-二聚体。结果与对照组比较,A组和B组患者同型半胱氨酸、高敏C反应蛋白和D-二聚体差异有统计学意义(P<0.05);与A组比较,B组同型半胱氨酸、高敏C反应蛋白和D-二聚体差异有统计学意义(P<0.05)。多因素logistic回归分析显示,同型半胱氨酸、高敏C反应蛋白和D-二聚体均为冠心病的危险因素。3组凝血酶原时间、活化部分凝血酶时间、纤维蛋白原比较差异无统计学意义(P>0.05)。结论同型半胱氨酸、高敏C反应蛋白和D-二聚体均是2型糖尿病患者发生冠心病的高风险因素。     

冠心病合并2型糖尿病患者的冠状动脉造影特点

目的　探讨冠心病合并 2型糖尿病 (T2 DM)患者的冠状动脉造影特点。方法　对 10 7例冠心病合并 T2 DM及6 77例非糖尿病冠心病患者冠状动脉造影资料进行统计分析。结果　冠心病合并 T2 DM患者的冠状动脉造影结果显示 ,多枝病变多于单枝、受累血管数目较多、左主干受累、弥漫性病变病例多见 ,均显著高于非糖尿病冠心病患者(P<0 .0 5 )。闭塞血管数目在糖尿病患者也高于非糖尿病患者 ,但未达到显著统计学差异。结论　冠心病合并T2 DM患者的冠状动脉血管受累明显较非糖尿病冠心病患者严重且病变更为弥漫     

Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus

BACKGROUND: Although the association between smoking and increased risk of coronary heart disease (CHD) is well established in the general population, this relationship is less well-defined among individuals with diabetes. OBJECTIVE: To assess the relationship between cigarette smoking and risk of CHD among women with type 2 diabetes mellitus in the Nurses' Health Study cohort. METHODS: The Nurses' Health Study, a prospective cohort study of 121,700 US female registered nurses surveyed in 11 states and followed up from July 1, 1976, through July 1, 1996, involved a total of 6547 women diagnosed as having type 2 diabetes mellitus. Incident cases of CHD were our main outcome measure in this study. RESULTS: We documented 458 incident cases of CHD (200 fatal CHD-related cases and 258 nonfatal myocardial infarctions) during 20 years (68,227 person-years) of follow-up. We found a dose-response relationship between current smoking status and risk of CHD among diabetic women. Compared with never smokers, the relative risks (RRs) for CHD were 1.21 (95% confidence interval [CI], 0.97-1.51) for past smokers, 1.66 (95% CI, 1.10-2.52) for current smokers of 1 to 14 cigarettes per day, and 2.68 (95% CI, 2.07-3.48) for current smokers of 15 or more cigarettes per day in multivariate analyses (P<.001 for trend). The multivariate RR of CHD among diabetic women who had stopped smoking for more than 10 years was similar to that among diabetic women who were never smokers (RR, 1.01; 95% CI, 0.73-1.38). In secondary analyses involving diabetic and nondiabetic women, the multivariate-adjusted RR of CHD for those with diabetes who currently smoked (> or = 15 cigarettes per day) compared with those who never smoked was 7.67 (95% CI, 5.88-10.01). CONCLUSIONS: Cigarette smoking is strongly associated with an increased risk of CHD among women with type 2 diabetes mellitus. Furthermore, quitting smoking seems to decrease this excess risk substantially; women with diabetes should be strongly advised against smoking.CK     

新双源flash-CT评价老年冠心病合并2型糖尿病患者血管成像特点

目的探讨老年冠心病（CAD）合并2型糖尿病（T2DM）患者冠状动脉CT血管成像（CTA）的成像特点。方法入选2012年10月至2013年10月冠状动脉造影检查确诊为CAD的老年患者640例,其中合并T2DM者350例,无合并T2DM者290例,冠状动脉造影后2周内行新双源flash-CT冠脉成像,分析老年CAD合并T2DM患者冠状动脉CTA的诊断特点。结果新双源flash-CT冠状动脉CTA对T2DM合并CAD患者冠状动脉病变的诊断特异性为89.6%。CAD合并T2DM患者冠状动脉钙化较严重,病变支数多,随着钙化积分的增高,特异性有所下降,但CTA对于介入治疗仍有指导作用。结论新双源flash-CT冠状动脉CTA是诊断老年CAD合并T2DM患者冠状动脉病变可靠、无创的检查方法,但严重钙化者要结合冠脉造影结果进行综合判断。     

Alcohol consumption and risk of coronary heart disease among men with type 2 diabetes mellitus

OBJECTIVES

The goal of this study was to examine the relationship between alcohol intake and risk of coronary heart disease (CHD) among men with type 2 diabetes.

BACKGROUND

Type 2 diabetes is associated with an increased risk of CHD. Emerging evidence suggests that moderate alcohol intake is associated with an important reduction in risk of CHD in individuals with type 2 diabetes.

METHODS

We studied 2,419 men who reported a diagnosis of diabetes at age 30 or older in the Health Professionals’ Follow-up study (HPFS). During 11,411 person-years of follow-up after diagnosis, we documented 150 new cases of CHD (81 nonfatal myocardial infarction [MI] and 69 fatal CHD). Relative risks (RR) were estimated from pooled logistic regression adjusting for potential confounders.

RESULTS

Alcohol use was inversely associated with risk of CHD in men with type 2 diabetes. The age-adjusted RRs corresponding to intakes of ≤0.5 drinks/day, 0.5 to 2 drinks/day and >2 drinks/day were 0.76 (95% confidence interval: [CI]: 0.52 to 1.12), 0.64 (95% CI: 0.40 to 1.02) and 0.59 (95% CI: 0.32 to 1.09), respectively, as compared with nondrinkers (p for TREND = 0.06). When we controlled for body mass index, smoking, family history of MI, hypertension, hypercholesterolemia, duration of diabetes, physical activity level, vitamin E supplements and intake of trans fat, polyunsaturated fat, fiber and folate, RRs were 0.78 (95% CI: 0.52 to 1.15), 0.62 (95% CI: 0.40 to 1.00) and 0.48 (95% CI: 0.25 to 0.94) (p for TREND = 0.03). The benefits of moderate consumption did not statistically differ by beverage type.

CONCLUSIONS

Moderate alcohol consumption is associated with lower risk of CHD in men with type 2 diabetes.     

糖尿病并发冠心病与周围神经病变关系的研究

目的探讨并发冠心病的糖尿病者（A组）与不伴冠心病的糖尿病者（B组）合并周围神经病变发生率的关系。方法对56例2型糖尿病者分别进行冠状动脉造影术（CAG）,根据其是否合并冠心病将病人分为A、B两组,分别进行肌电图检查,比较两组周围神经病变发生率的关系。结果 A组周围神经病变的发生率明显高于B组,差异具有统计学意义（P〈0.05）。结论 2型糖尿病者在合并有冠心病的基础上,周围神经病变的发生机率大大增加。     

老年冠心病伴2型糖尿病患者临床相关危险因素及冠状动脉造影特点分析

目的探讨老年冠心病伴2型糖尿病患者临床相关危险因素及冠状动脉造影特点。方法471例经冠状动脉造影确诊的老年冠心病（年龄≥60岁）患者,将其分为冠心病伴2型糖尿病组（179例）,单纯冠心病组（292例）。对比分析两组患者临床相关危险因素及冠状动脉造影资料。结果多因素非条件的logistic回归分析显示,低密度脂蛋白胆固醇（LDL—C）、空腹血糖（FBG）、餐后2h血糖（2hPBG）是2型糖尿病并发冠心病的独立危险因素（P≤0．001）。与单纯冠心病组相比较,冠心病伴2型糖尿病组发生3支病变较多（P〈0．01）、冠状动脉重度狭窄、完全闭塞及弥漫病变比例更高（P〈0．01）,其Gensini积分亦显著高于单纯冠心病组（P=0．009）。结论LDL-C、FBG及2hPBG是老年2型糖尿病并发冠心病的独立危险因素,老年冠心病伴2型糖尿病患者冠状动脉累及范围广且程度重。     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的探讨冠心病(CHD)合并2型糖尿病患者的冠状动脉造影特点。方法从冠状动脉造影病例中选取454例(其中冠心病合并2型糖尿病203例,单纯冠心病251例)进行血生化和血管造影资料对比分析。结果与单纯冠心病组比较,冠心病合并2型糖尿病组甘油三酯(TG)水平高,载脂蛋白A(apoA)水平低;四支病变比例高(17.3%比9.5%,P<0.05),单支病变比例低(16.3%比26.3%,P<0.05),且血管狭窄程度重(狭窄程度≥75%的比例为66%比61.3%,P<0.05)。结论合并2型糖尿病与不合并2型糖尿病的冠心病患者的冠状动脉造影表现的差异有统计学意义,前者冠状动脉病变更加广泛和严重。     

2型糖尿病合并冠心病患者微量蛋白尿检测的临床意义

目的探讨2型糖尿病合并冠心病患者微量蛋白尿检测的临床意义。方法按照微量蛋白尿分组,对184例2型糖尿病合并冠心病患者的临床资料及冠状动脉造影（CAG）结果进行对照分析。结果与微量蛋白尿阴性组相比,微量蛋白尿阳性组患者具有高龄、高血压、高体重指数、高血糖、高甘油三酯、高低密度脂蛋白胆固醇等心血管危险因素,且CAG单支血管病变少,多支血管及弥漫性病变多,血管狭窄程度重,左室射血分数低,心肌梗死和心力衰竭的发生率高。结论微量蛋白尿检测可作为早期预测2型糖尿病合并冠心病患者冠状动脉病变的指标之一。微量蛋白尿阳性的2型糖尿病合并冠心病患者冠状动脉广泛、弥漫且严重。     

Silent coronary artery disease in patients with type 2 diabetes mellitus

Abstract. The purpose of this study was to estimate the prevalence and risk factors of silent CAD in asymptomatic type 2 diabetic patients aged over 40 years. A total of 172 asymptomatic type 2 diabetic patients, mean age 54.42 years, with normal resting electrocardiogram were included in the study. Technetium-99m (Tc-99m) tetrofosmin cardiac single photon emission computed tomography myocardial scintigraphy with exercise testing or dipyridamole injection was performed on all patients. If this test was positive, coronary angiography was carried out and was considered to be positive with a stenosis of 70%. Abnormal perfusion pattern was found in 14 patients (8.14%). Significant coronary artery stenosis was found in 13 subjects (7.56%), confirming a high positive predictive value (92.86%) of this diagnostic procedure. A significant correlation was observed between silent CAD and male sex, retinopathy, hypertension, post-prandial blood glucose level, and low HDL-cholesterol level. Sex (OR=4.026; 95% CI, 1.187–13.659), hypertension (OR=5.564; 95% CI, 1.446–21.400) and retinopathy (OR=3.766; 95% CI, 1.096–12.948) were risk factors for CAD. Overall, 14.06% of asymptomatic male patients with type 2 diabetes mellitus presented silent CAD with significant angiographically documented coronary stenosis. This finding, along with the high positive predictive value of a noninvasive technique, indicates that routine screening for silent CAD would be useful in this patient subgroup especially when they have retinopathy or hypertension.     

老年2型糖尿病合并冠心病患者冠状动脉造影及临床特点分析

目的了解老年2型糖尿病合并冠心病患者的临床及冠状动脉病变的造影特点。方法对185例经冠状动脉造影诊断的老年冠心病患者分为两组:有糖尿病组(DM)和无糖尿病组(NDM),分析比较了两组的临床表现及冠状动脉病变的造影特点。结果(1)两组间年龄、吸烟、高血压及心肌梗死率的差异均无显著性意义。甘油三酯(TG)水平DM组较NDM组高(P<0.05)。(2)两组病变血管数量及侧支循环形成情况比较差异无显著性,两组的病变血管分布状况相似。(3)两组冠脉狭窄支数、狭窄程度比较差异均无显著性,DM组的冠脉狭窄范围较NDM组广泛(3.17vs2.44,P<0.05),DM组冠状动脉狭窄<50%的血管片段数高于NDM组。结论老年糖尿病合并冠心病患者的冠状动脉更倾向于弥漫性病变,高TG可加重DM的冠状动脉病变。     

女性冠心病合并糖尿病患者冠状动脉病变特点

目的:探讨冠心病合并糖尿病患者冠状动脉病变特点及其相关危险因素,以及糖尿病对冠状动脉病变的作用机制。方法:2000年7月至2003年12月行冠状动脉造影术(CAG)确诊为冠心病的女性患者162例,年龄45～81岁,平均(60.63±8.41)岁。按有无糖尿病(DM)分为DM组41例,非DM组121例,2组之间比较其相关临床因素及造影情况、治疗情况,进行卡方检验或t检验,分析其差异有无显著性。结果:1.DM组与非DM组比较,胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、体重指数(BMI)均差异有显著性,除HDL外,余指标均为DM组高。DM组高血压、心肌梗死、冠心病发生率高于非DM组(P<0.05);2.DM组病变血管支/人、多支病变、弥散病变、血管中重度狭窄病变数及百分比均高于非DM组(P<0.05);3.DM组需经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)人数及百分比也高于非DM组(P<0.05)。结论:糖尿病是发生冠心病的独立危险因素,并常与高血压、脂代谢紊乱/或肥胖等因素同时存在。女性冠心病伴发糖尿病者,其冠状动脉病变程度加重,多支病变、弥散病变多、心肌梗死等危险心脏事件发生率高。     

2型糖尿病合并冠心病危险因素分析

目的 分析２型糖尿病合并冠心病危险因素。方法 应用多因素Ｌｏｇｉｓｔｉｃ回归,分析了４０５例２型糖尿病患者有关冠心病的危险因素。结果 （１）２型糖尿病病人冠心病发生率为２６．２％;（２）年龄,糖尿病病程,高血压,体重指数,空腹血清Ｃ肽,甘油三酯,血清尿酸７个因素与Ⅱ型糖尿病病人冠心病发病有关。结论除了常见的冠心病危险因素外,为了防止２型糖尿病病人冠心病的发生,亦应注意控制高胰岛素血症,高甘油三酯血     

合并冠心病的糖尿病患者临床特征分析

目的比较有否合并冠心病（CHD）的糖尿病（DM）患者的临床特点,为预测DM患者发生CHD的危险性提供参考依据。方法将336例DM患者分为CHD组（267例）和非冠心病（non-CHD）组（69例）。比较两组患者的一般情况、血脂、糖代谢等生化指标和炎症指标的差异。并通过logistic回归筛选DM患者CHD的独立危险因素。结果两组相比,DM病程、吸烟史、腰臀比、HDL-C、FPG、HbA1c、肌酐、hsC-RP、WBC和中性粒细胞百分比存在统计学差异。其中,DM病程、吸烟史、HDL-C和FPG是DM患者发生CHD的独立危险因素,比值比分别为0.925、3.576、2.839和0.819。结论DM病程长、有吸烟史、HDL-C水平低、FPG水平高的DM患者合并CHD的可能性更大。     

老年冠心病合并2型糖尿病的冠脉CTA评价

目的：利用冠脉计算机断层血管摄影术（CTA）评价老年冠心病伴有2型糖尿病患者的冠脉病变及斑块特点。方法：采用GE light speed 64排螺旋CT对合并2型糖尿病的冠心病患者58例（DM组）,不合并2型糖尿病的冠心病62例患者（NDM组）的临床及冠脉病变进行对照分析。结果：CTA检出共有170支冠脉血管病变和224个节段病变,斑块最常见部分为左前降支近段及右冠脉。与NDM组比较,DM组病人发病年龄更轻[（69.5±10.2）岁比（65.33±9.8）岁,P〈0.05],临床上伴有高血压更多（13.3%比23.3%,P〈0.05）,高血脂（3.3%比16.7%,P〈0.05）,而且其冠脉血管病变中多支（35%）及弥漫病变较多见（35%）,最常见斑块是混合斑块（82.8%）;NDM病人单支病变较多见（56%）,钙化范围大,最常见斑块是钙化斑块（71.0%）。结论：冠心病合并2型糖尿病患者斑块发生率较高,多支病变及弥漫病变较多见,对其进行多层螺旋CT检查有利于早期风险评估。     

老年2型糖尿病合并冠心病的危险因素分析

目的 探讨老年2型糖尿病(T2DM)合并冠心病的危险因素.方法 选择2010年8月至2012年8月我院收治的120例2型糖尿病患者为研究对象,根据是否合并冠心病将其分为两组,对两组患者的临床资料进行比较分析,探讨影响T2DM合并冠心病的危险因素.结果 观察组的病程、BMI、SBP、TG、HDL-C、LDL-C、UA等指标与对照组相比差异有统计学意义(P＜0.05).Logistic回归分析结果显示,糖尿病合并冠心病的危险因素为病程＞10年、高血压、高血脂、高血清尿酸.结论 病程＞10年、高血压、高血脂、高血清尿酸为老年2型糖尿病合并冠心病的危险因素.     

The study of coronary angiography clinical features in patients with coronary heart disease and type 2 diabetes mellitus

目的 探讨2型糖尿病合并冠心病患者的冠状动脉(以下简称冠脉)病变特征及其相关因素.方法 选取2007年12月～2011年5月在我院经冠脉造影证实为冠心病的患者共306例.按是否合并2型糖尿病分为合并2型糖尿病组(143例)及未合并2型糖尿病组(非糖尿病组,163例).检测指标包括患者的病史、人体基本参数及代谢生化指标.所有患者均进行了床边心电图和冠状动脉造影检查.结果 与非糖尿病组相比,2型糖尿病组患者空腹血糖、餐后2小时血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、半胱胺酸蛋白酶抑制剂C、收缩压及舒张压明显升高(P均＜0.05),而胸痛症状的发生率明显降低(P＜O.01).2型糖尿病组患者窦性心律失常发生率、室性心律失常发生率及传导阻滞发生率均明显升高(P＜0.05).冠脉病变特征比较显示,2型糖尿病组单支冠脉病变发生率明显降低(P＜0.05),3支冠脉病变发生率明显升高(P＜0.01).在受累血管病变程度的统计中,2型糖尿病组弥漫性病变发生率明显高于非糖尿病组(P＜0.01).结论 合并2型糖尿病的冠心病患者存在着病变更广泛而严重、代谢紊乱及合并症发生率更高的特征,具有更高的致死风险.     

2型糖尿病伴冠心病患者血清胱抑素C水平及其意义

目的:探讨血清胱抑素C(Cys C)水平与2型糖尿病伴冠心病的关系。方法:收集40例单纯2型糖尿病患者(DM组)、120例2型糖尿病伴冠心病(CHD)患者(DM+CHD组)及40例健康者(对照组)的血清。分别测定基础代谢率、血压、血脂、血清糖化血红蛋白及Cys C水平。结果:血清Cys C水平在DM组[(1.58±0.78)mg/L]、DM+CHD组[(2.12±0.94)mg/L]较对照组[(0.82±0.23)mg/L]明显升高,差异有统计学意义(P<0.01),DM+CHD组明显高于DM组(P<0.05)。冠状动脉狭窄支数越多,血清Cys C水平越高。结论:2型糖尿病伴CHD患者的血清Cys C水平增高,且随冠状动脉狭窄病变支数的相应增加呈增高趋势,提示Cys C在2型糖尿病伴CHD的发生发展中起一定作用。