空腹血糖结合HbA1C诊断冠心病患者糖尿病的价值

比较空腹血糖结合HbA1C诊断的与口服糖耐量试验（CGTT）诊断的2360例冠心病住院患者糖尿病的真实性及不同组的阳性似然比，空腹血糖结合HbA1C的方法筛查冠心病患者糖代谢异常有较好的特异度和灵敏度。     

Low fasting plasma glucose level predicts morbidity and mortality in symptomatic adults with congenital heart disease

Background

Adults with complex congenital heart disease (ACHD) have a high prevalence of abnormal glucose regulation (AGR: impaired glucose tolerance and diabetes mellitus). However, the impact of AGR on the prognosis remains unclear.

Purpose

Our purpose was to clarify the prognostic value of AGR in ACHD.

Methods and results

We performed a 75 g oral glucose tolerance test in 438 consecutive patients with ACHD (age 26 ± 8 years), including 38 unrepaired, 148 Fontan, 252 biventricular, and 27 healthy subjects and investigated associations between AGR and clinical events that required hospitalization or caused deaths from all-causes. When compared with the healthy group, fasting blood glucose level (FPG, mg/dl) was lower in the unrepaired and Fontan subjects (p < 0.05–0.01) and the prevalence of low FPG (≤ 80 mg/dl) was also higher in the unrepaired (58%), Fontan (47%), and biventricular group (33%) than in the healthy control (11%) (p < 0.0001). Postprandial hyperglycemia (area under the curve of glucose: PG-AUC) was higher in all ACHD groups (p < 0.0001 for all). New York Heart Association class and lower FPG independently predicted the hospitalization (FPG ≤ 84 mg/dl) and mortality (FPG ≤ 80 mg/dl) (p < 0.05–0.0001), while the PG-AUC was not an independent predictor. When compared with the asymptomatic ACHD, symptomatic ACHD with lower FPG had high hazard ratios of 2.2 (95% confidence interval [CI]: 1.3–3.8, p < 0.002) and 3.3 (95% CI: 1.2–11.9, p < 0.03) for the hospitalizations and all-cause mortality, respectively.

Conclusions

Low FPG is not uncommon in ACHD and the low FPG predicts the morbidity and all-cause mortality in symptomatic ACHD.     

Moderate alcohol consumption and postprandial plasma lipids in men with different risks for coronary heart disease

BACKGROUND: Moderate alcohol consumption is associated with a reduced coronary heart disease (CHD) risk. Epidemiologic studies have provided conflicting data which suggests that CHD protection may be modulated or may not be modulated by a person's CHD risk profile. METHODS: We examined the effects of moderate alcohol consumption (35 g/day) on postprandial lipoprotein metabolism in two groups of healthy middle-aged men who had different plasma total cholesterol, triglyceride concentrations, and body mass index (BMI), which are three major risk factors for CHD; 11 men had lower plasma lipids and BMI (L-men) and 11 men had higher plasma lipids and BMI (H-men). The effects of alcohol on postprandial lipoprotein metabolism were studied in a crossover design after an acute moderate alcohol intake both after a period of abstinence (alcohol-free beer) and after a period of moderate alcohol consumption (alcohol containing beer). RESULTS: Moderate alcohol consumption changed plasma total cholesterol, total triglycerides, and HDL composition in the postprandial period. Alcohol-induced changes were essentially the same over time in both L-men and H-men. However, changes occurred at a different overall plasma concentration for total cholesterol and total triglycerides. Also, the postprandial response to an acute moderate alcohol dose after a period of abstinence seemed not to essentially differ from the response to an acute moderate alcohol dose after a 4-week period of moderate alcohol consumption. CONCLUSIONS: These results suggest that men who differ in risk for CHD, based on plasma lipids and BMI, but without previous or underlying disease, have a similar postprandial lipid response to a moderate dose of alcohol.     

冠心病患者冠状动脉病变与糖耐量变化的关系

目的　探讨冠心病患者糖耐量变化与冠脉病变之间的关系。方法　 193例冠心病患者根据WHO(1985 )和美国糖尿病学会 (1997)糖尿病诊断标准分为单纯冠心病〔糖耐量正常 (NGT)〕组12 2例 ,冠心病合并糖耐量异常 (IGT)组 39例 ,冠心病合并 2型糖尿病 (DM)组 32例 ,所有研究对象均行冠脉造影 (CAG)和口服 75克葡萄糖耐量试验 ,检测血糖、胰岛素、血脂。冠脉病变程度应用CAG分析 ,冠脉狭窄程度根据美国心脏学会分类标准评价 ,冠脉病变的危险因素应用多元逐步直线回归分析。结果　 (1)冠心病合并IGT组多支冠脉病变的发生率明显高于单纯冠心病组 (6 6 .5 %vs 35 .1% ,P <0 .0 5 ) ,冠脉狭窄程度 (8.9± 3.6vs 6 .5± 3.9,P <0 .0 5 )及钙化的程度 (6 .3± 3.6vs 3.9± 4 .1,P <0 .0 5 )明显高于单纯冠心病组 ,冠脉远端的病变发生率明显高于单纯冠心病组 (40 .8%vs 13.1% ,P<0 .0 5 )。 (2 )冠心病合并IGT组与冠心病合并DM组相比 ,多支冠脉病变的发生率、冠脉粥样硬化及钙化的程度及冠脉远端的病变发生率差异无显著性。 (3)血脂、胰岛素、血压与冠脉粥样硬化程度有明显相关性。结论　与冠心病合并DM患者相似 ,冠心病合并IGT患者多支冠脉病变的发生率高 ,病变多呈弥漫性狭窄 ,远端血管病变发生率较高 ,程度严重。血     

冠心病合并不同糖代谢状态患者血8-羟基脱氧鸟苷水平与胰岛素抵抗指数和糖化血红蛋白相关性

目的 观察稳定性冠心病合并不同糖代谢患者的8-羟基脱氧鸟苷（8-OHdG）水平并探讨其临床意义.方法 采用口服75 g葡萄糖耐量试验（OGTT）将77例稳定性冠心病患者分为正常糖耐量（NGT）组26例、单纯糖耐量异常（IGT）组26例和2型糖尿病（T2DM）组28例,同时选择23例健康体检者为健康对照（NC）组,用ELISA方法测定所有入选者血8-OHdG 的含量.结果 血8-OHdG含量在T2DM组为（4.5±0.7）ng/ml,IGT组为（3.8±0.9）ng/ml,NGT组为（3.4±0.5）ng/ml,均较健康对照组（2.9±0.7）ng/ml明显升高（P＜0.05）,且与胰岛素抵抗指数（HOMA-IR）和糖化血红蛋白（HbA1c）呈正相关.结论 血8-OHdG水平反映了氧化应激,可能对稳定性冠心病合并糖尿病有预测价值.     

Relationship between insulin resistance, weight loss, and coronary heart disease risk in healthy, obese women.

Several popular books have recently been published stating that being insulin-resistant favors weight gain and/or prevents weight loss. Because this view seems to have gained widespread support in the general population, we thought it important to perform the current study testing the hypothesis that differences in insulin-mediated glucose disposal do not affect weight loss in response to calorie-restricted diets. For this purpose, we studied the change in weight and risk factors for coronary heart disease (CHD) in healthy women volunteers, defined as being obese on the basis of a body mass index (BMI) greater than 30.0 kg/m(2). The insulin suppression test was used to stratify obese women at baseline into insulin-resistant and insulin-sensitive subgroups on the basis of their steady-state plasma glucose (SSPG) concentration at the end of a 180-minute infusion of octreotide, exogenous insulin, and glucose. They were then instructed on a calorie-restricted diet plus sibutraminine (15 mg/day) for a total period of 4 months. Baseline measurements also included determination of fasting lipid and lipoprotein concentrations, and hourly (8 AM to 4 PM) determinations of plasma glucose and insulin concentrations before and after breakfast and lunch. Twenty-four women completed the 4-month period of calorie restriction: 13 classified as insulin-resistant (SSPG = 219 +/- 7 mg/dL) and 11 as insulin-sensitive (SSPG = 69 +/- 6 mg/dL). The insulin-resistant group also had higher (P =.03) plasma triglyceride (TG) concentrations and a higher ratio of total to high-density lipoprotein (HDL) cholesterol concentration (P =.02) at baseline. Both groups lost a significant amount of weight during the study, and there was no difference between the weight loss in the insulin-resistant (8.6 +/- 1.3 kg) and insulin-sensitive (7.9 +/- 1.4 kg) groups. Weight loss in the insulin-resistant group was also associated with a significant decrease in SSPG concentration (219 +/- 7 to 144 +/- 14 mg/dL), associated with significantly lower fasting TG concentrations (P <.001) and day-long concentrations of plasma glucose and insulin (P <.005). None of these variables changed in the insulin-sensitive group. These results indicate that: (1) CHD risk factors in obese women vary as a function of being insulin-resistant or insulin-sensitive; (2) dramatic variations in insulin-mediated glucose disposal do not modulate weight loss in response to calorie-restricted diets, and (3) weight loss is effective in reducing CHD risk in insulin-resistant, obese women. Given these data, it seems obvious that attempts to reduce CHD risk factors by weight loss should focus on obese individuals who are also insulin-resistant.     

冠心病并糖耐量受损患者胰岛素抵抗与冠状动脉病变程度的相关性研究

目的探讨冠心病合并葡萄糖耐量受损(IGT)患者胰岛素抵抗(IR)与冠状动脉病变程度之间的关系。方法 152例冠心病并IGT患者及35例冠心病非IGT患者(对照组),采用HOMA2法测定IR指数(HOMA2-IR),采用Gensini积分系统定量评定冠状动脉狭窄程度,B2/C型病变定义为冠状动脉形态学复杂病变。以HOMA2-IR四分位数为切点将冠心病并IGT患者分为4组:第1四分位数组(n=38)、第2四分位数组(n=38)、第3四分位数组(n=38)、第4四分位数组(n=38),比较5组基线资料及冠状动脉造影结果。结果 5组间餐后2 h血糖(2h PBG)、糖化血红蛋白(Hb A1c)、空腹胰岛素和Gensini积分逐渐增高,差异有统计学意义(P0.01)。第4四分位数组多支病变和B2/C病变明显高于第1四分位数组和对照组(P0.05)。相关性分析显示,Gensini积分与HOMA2-IR(r=0.712,P0.001)存在较强的正相关。多元逐步回归分析显示,HOMA2-IR、Hb A1c和2h PBG是影响冠状动脉狭窄程度的独立危险因素。Logistic回归分析显示,HOMA2-IR是多支病变和B2/C病变的独立危险因素。结论IR是反映冠心病并IGT患者冠状动脉狭窄程度的重要指标。     

冠心病患者血浆脑钠肽与心功能相关性的临床观察

目的评价冠心病(CHD)患者血浆脑钠肽(BNP)浓度变化与心功能的相关性。方法用微粒子酶免化学发光法(MEIA)检测86例CHD患者血浆BNP浓度,分析其与NYHA心功能分级之间的相关性,并比较其与并发症之间的关系。结果①血浆BNP浓度与NYHA心功能分级成正相关(P<0.01);②CHD并发症与BNP浓度之间存在相关关系;③血浆BNP浓度对CHD心功Ⅰ级的诊断界值选76pg/Ml,其灵敏度为60%。结论BNP测定可用来判断CHD患者心脏功能状态,尤其是隐匿性心力衰竭(HF)患者。     

胰岛素抵抗与冠心病危险因素及冠状动脉病变程度的相关分析

目的　通过胰岛素抵抗与冠心病危险因素及冠状动脉病变的相关分析 ,探讨胰岛素抵抗对冠心病的作用机制。方法　连续收集经冠状动脉造影证实至少有一支血管狭窄≥ 5 0 %的 12 3名患者作为研究对象 ,并排除有甲状腺和严重肝、肾、胰腺疾患及使用胰岛素治疗的糖尿病患者。均行口服葡萄糖耐量 (OGTT)试验及血脂、胰岛素测定。以HOMA值作为评价胰岛素抵抗程度指标 ,对冠心病危险因素、冠状动脉病变程度、危险因素聚集 (高血压病、糖耐量异常 糖尿病、超重、高甘油三酯血症、低高密度脂蛋白胆固醇 5个危险因素计分 )行相关分析。结果　胰岛素抵抗与体重指数、空腹血糖、餐后血糖、空腹胰岛素、餐后胰岛素、甘油三酯、高密度脂蛋白胆固醇、高血压病史均有明显相关性 ,而且随着胰岛素抵抗程度增加 ,这些冠心病危险因素聚集性呈增加趋势 ,冠状动脉的病变范围、病变程度也呈增加趋势。结论　胰岛素抵抗可能是疾病的基础 ,在冠心病Ⅰ、Ⅱ级预防中不仅要对症治疗 ,更重要的是采取降低胰岛素抵抗等综合治疗措施。     

Dietary patterns in association with the risk of elevated blood pressure,lipid profile and fasting plasma glucose among adults in Jiangsu Province of China

Background and AimsThis study aimed to identify unique dietary patterns, and to examine the correlation of dietary patterns with elevated blood pressure, lipid profile and fasting plasma glucose (FPG) among adults in Jiangsu Province of China.Methods and results4951 individuals were selected in this cross-sectional study from nutrition and health survey in Jiangsu Province in 2014. Factor analysis was used to identify the dietary patterns. Higher quartile of the cereals-seafood-dairy dietary pattern was inversely associated with high low-density lipoprotein cholesterol (LDL) (composed to Q1, OR = 0.834, 95% CI: 0.700～0.993, P < 0.05) and FPG (composed to Q1, OR = 0.725, 95% CI: 0.609–0.862, P < 0.05), while higher quartile of the traditional Jiangsu dietary pattern was positively associated with low high-density lipoprotein cholesterol (HDL) (composed to Q1, OR = 1.395, 95% CI: 1.067～1.825, P < 0.05) and high systolic blood pressure (SBP) (composed to Q1, OR = 1.238, 95% CI: 1.020～1.503, P < 0.05). Higher scores of the refined food-oriented dietary pattern was inversely related to high triglycerides (TG) (composed to Q1, OR = 0.665, 95% CI: 0.551～0.802, P < 0.05), but was positively related to high TC (composed to Q1, OR = 2.179, 95% CI: 1.817～2.614), high LDL (composed to Q1, OR = 2.431, 95% CI: 2.037～2.902, P < 0.05) and elevated FPG (composed to Q1, OR = 1.734, 95% CI: 1.458～2.061, P < 0.05).ConclusionDifferent structure of dietary patterns do affect the blood pressure, lipid profile and fasting plasma glucose among adults in Jiangsu Province, China.     

卡维地洛与美托洛尔对2型糖尿病合并冠心病血糖血脂影响

目的探讨卡维地洛与美托洛尔对2型糖尿病合并冠心病病人糖、脂代谢影响。方法确诊为2型糖尿病合并冠心病病人116例,随机分成2组,分别接受卡维地洛和美托洛尔治疗,随访6个月,检查治疗前后血糖、血脂及其相关指标变化。结果卡维地洛治疗组空腹血糖及胰岛素水平、血脂水平均比治疗前有下降,而美托洛尔治疗组血糖水平较前升高,血脂水平改变不明显。结论卡维地洛与美托洛尔治疗糖尿病合并冠心病病人对糖、脂代谢的影响差异有统计学意义。     

血清尿酸水平与老年冠心病患者易感风险因素的相关性研究

目的分析血清尿酸水平与老年冠心病易感风险因素的相关性。方法回顾性采集2017年1月至2019年1月我医院老年冠心病患者200例(冠心病组)和同期医院门诊接诊的非冠心病老年患者150例(对照组)的临床资料。患者入院后即刻采集外周静脉血,测定血清尿酸水平;并记录各基线资料情况,将冠心病可能的易感风险因素纳入,经单因素与多因素分析找出风险因素,分析血清尿酸水平与老年冠心病患者各易感风险因素的相关性。结果初步单因素分析发现,吸烟、合并糖尿病、低高密度脂蛋白胆固醇(HDL-C)血症、冠心病家族史、肾小球滤过率等均可能是老年冠心病患者易感风险因素(χ^2=6.739、15.655、6.331、9.615、23.279,P均<0.05);多因素分析证实,吸烟、合并糖尿病、低HDL-C血症、冠心病家族史、肾小球滤过率均是老年冠心病易感风险因素(OR=1.777、2.381、1.883、1.967、3.205,均P<0.05);吸烟、合并糖尿病、低HDL-C血症、有冠心病家族史、肾小球滤过率<100 ml/min的老年冠心病患者,其血清尿酸水平均高于其他患者(t=8.017、5.907、8.509、7.164、13.839,均P<0.001);经Spearman相关性分析检验证实,血清尿酸水平与老年冠心病患者吸烟、合并糖尿病、冠心病家族史等易感风险因素均呈正相关(r=0.409、0.422、0.422,均P<0.001),与低HDL-C血症、肾小球滤过率呈负相关(r=-0.428、-0.481,均P<0.001)。结论血清高尿酸水平与吸烟、糖尿病等诸多冠心病易感风险因素有紧密联系,可能是冠心病发病的独立危险因素。     

The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin

Aims

We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox.

Background

The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF).

Methods

Prospective study of 4046 men aged 60–79 years followed up for a mean period of 11 years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF.

Results

Overweight (BMI 25–9.9 kg/m²) and obesity (BMI ≥ 30 kg/m²) were associated with lower mortality risk compared to men with normal weight (BMI 18.5–24.9 kg/m²) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p = 0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p = 0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p = 0.60 for trend) but made minor differences to those with HF [p = 0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p = 0.98 for trend].

Conclusion

The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.     

Link between plasma ceramides, inflammation and insulin resistance: association with serum IL-6 concentration in patients with coronary heart disease

Aims/hypothesis  

Ceramides and IL-6 have a role in immune–inflammatory responses and cardiovascular diseases, and are suggested to be involved in insulin and glucose metabolism. We sought to assess the associations of circulating levels of IL-6, TNF-α and high-sensitivity C reactive protein (hsCRP), which are inflammatory markers related to insulin resistance (IR), with the plasma lipid metabolites ceramides and diacylglycerols (DAG) in patients with CHD.     

Fasting blood glucose and risk of coronary heart disease, stroke, and all-cause mortality: a 17-year follow-up study of men born in 1913

This report concerns the relationship between baseline levels of fasting blood glucose (FBG) in non-diabetics and the subsequent 17-year incidence of coronary heart disease (CHD), stroke and all-cause mortality. In 1963, 973 men aged 50 years were recruited from a general Swedish urban population for a prospective study of risk factors for CHD. Eight hundred and fifty-five (88%) men agreed to participate and have been observed for 17 years. The 832 men who had no history of myocardial infarction, stroke, diabetes mellitus or who had a fasting blood glucose below 7.0 mmol/l at baseline were selected for this analysis. CHD occurred in 106 men, 35 developed a stroke and 137 died during follow-up. When quintiles and deciles of the FBG distribution were considered, no trend of 17-year incidence of CHD, stroke or death was apparent. However, for men with an FBG above the 95th percentile (greater than 5.7 mmol/l) a non-significant trend towards increasing risk was indicated.     

冠心病患者载脂蛋白A5与脂联素和空腹胰岛素的关系研究

目的 探讨冠心病患者血清载脂蛋白A5(APOA5)与脂联素和空腹胰岛素(FINS)之间的关系.方法 检测2005年6月至12月在中南大学湘雅二医院心内科住院确诊的51例冠心病患者和同期在此院门诊进行健康体检的44名健康对照者血清APOA5、脂联素、FINS和血脂,并计算胰岛素抵抗指数(HOMA-IR).结果 冠心病组血清APOA5和脂联素显著低于健康对照组[(230.06±115.80)μg/L对(324.43±151.79)μg/L,(3.03±1.85)mg/L对(4.12±2.48)mg/L,P均＜0.05];冠心病组的FINS显著高于对照组[(9.85±5.94)mU/L对(7.85±3.04)mU/L,P＜0.05].APOA5与三酰甘油(TG)、FINS、HOMA-IR呈负相关,与高密度脂蛋白胆固醇(HDL-C)呈正相关,与脂联素不相关.结论 冠心病患者血清APOA5和脂联素降低,FINS增高.APOA5不但影响血脂代谢,而且可能与胰岛素抵抗有关.     

盐酸阿罗洛尔和美托洛尔对冠心病患者血压、心率、血脂和血糖的影响

目的 比较盐酸阿罗洛尔和美托洛尔对于冠心病患者的血压、心率、血糖、血脂的影响.方法 连续收集3个月90例冠心病病例,随机分成两组:盐酸阿罗洛尔组(A组)和美托洛尔组(B组),分别在原来治疗的基础上加用盐酸阿罗洛尔和美托洛尔.结果 12周后,A组收缩压、舒张压、心率均有显著下降,降幅分别为11.1 mm Hg、8.9 mm Hg、8.3次/分;B组收缩压、心率有显著下降,降幅分别为6.7 mm Hg、8.2次/分.A组患者高血糖比例呈下降趋势(降幅9.1%),而B组呈上升趋势(降幅-2.4%).A、B两组平均血脂水平(包括甘油三酯、总胆固醇、高密度脂蛋白)和平均空腹血糖无明显变化,但A组平均空腹血糖水平有下降趋势(降低1.7 mmol/L).结论 盐酸阿罗洛尔是适应于冠心病患者的有效的β受体阻滞剂,尤其是对于合并高血压、糖代谢紊乱的患者,有可能成为首选用药.