从冠脉造影病变程度及心血管危险因素角度探讨空腹血糖受损界值下降的临床意义

目的 通过分析不同空腹血糖(FPG)水平下的冠状动脉病变程度及心血管危险因素,探讨空腹血糖受损切点下调的意义.方法 回顾分析911例高度怀疑冠心病而行冠状动脉造影患者的临床资料,在不同FPG水平下对冠状动脉病变程度(以病变支数和冠状动脉积分表示)及心血管危险因素进行分析.结果 (1)在校正了年龄、性别、高血压等影响因素后,与FPG<5.6mmol/L组比较,FPG 5.6～6.0mmol/L组在冠状动脉病变支数上差异有显著性(P<0.05);FPG 6.1～6.9mmol/L组无论在冠状动脉病变总积分,还是冠状动脉病变累及支数上均有显著性差异(均P<0.01).(2)按FPG间隔分组,结果显示高血压、血脂紊乱、肥胖及代谢综合征的比率均随着FPG升高逐步上升;除血脂紊乱比率自5.0～5.6mmol/L组开始明显升高外,肥胖、高血压及代谢综合征的比率均自5.6～6.0mmol/L组开始显著上升(P<0.05);FPG≥5.6mmoL/L时心血管危险因素开始明显聚集.结论 (1)冠心病高危人群的冠状动脉病变程度即使在糖尿病前期已随着FPG升高逐步加重,FPG 5.6mmol/L以上冠状动脉发生病变的风险已开始增加,6.1mmol/L以上更为明显.(2)心血管危险因素在糖尿病前期已开始随FPG增高而逐步上升,自FPG 5.6mmol/L以上开始出现明显聚集.

Clinical significance of lowering the cut-point of impaired fasting glucose: in view of the extent and severity of angiographic coronary artery disease and the cardiovascular risk factors

Objective To evaluate the rationale of lowering the cutoff value of impaired fasting glucose(IFG)by studying the extent and severity of angiographic coronary artery disease(CAD)and the cardiovascular risk factors in subjects with different fasting plasma glucose(FPG)levels. Methods A total of 911 consecutive patients who had undergone coronary angiography were selected according to inclusion criteria. The subjects were studied in view of the extent and severity of angiographic CAD and the cardiovascular risk factors with different FPG levels. Results (1) Compared with the group of FPG<5.6mmol/L, the numbers of diseased vessels in the group with FPG 5.6-6.0mmol/L were significantly increased(P<0.05)after adjustment of age, sex and other influencing factors; the group with FPG 6.1-6.9mmol/L had both raised number of diseased vessels and the CAD Gensini cumulative index(P<0.01). (2) The prevalences of overweight, hypertension, hypertriglyceridemia, metabolic syndrome were progressively increasing with graded FPG levels. The prevalence of hypertriglyceridemia was significantly increased with FPG level at 5.0-5.6mmol/L(P<0.05),and the prevalences of metabolic syndrome and other components were significantly elevated with FPG level at 5.6-6.0mmol/L(P<0.05). Conclusion (1) The extent and severity of angiographic CAD were increased with increased FPG even in prediabetic period. The risk of angiographic CAD became increased significantly with FPG at 5.6-6.0mmol/L level. (2) The cardiovascular disease(CVD)risk was also increased with increasing FPG even in prediabetic period. The phenomenon of clustering of CVD risk factors was found at FPG 5.6mmol/L.