糖尿病前期冠心病患者血糖水平与冠状动脉病变的相关性

目的探讨糖尿病前期冠心病患者血糖水平与冠状动脉病变程度的相关性。方法回顾分析经冠状动脉造影确诊冠心病（CHD）386例患者的临床资料，冠状动脉造影病变程度以冠状动脉病变支数、是否弥漫性病变和冠状动脉病变Gensini总积分三方面表示；根据空腹血糖（FPG）及口服葡萄糖耐量试验2h血浆葡萄糖（2hPG）水平将所有研究对象分为4组：血糖正常组（FPG〈5．6mmol／L且2hPG〈7．8mmol／L，97例）、单纯血糖受损组（5．6≤FPG〈7．0mmol／L且2hPG〈7．8mmol／L，99例）、单纯糖耐量受损组（FPG〈5．6mmol／L且7．8≤2hPG〈11．1mmol／L，111例）以及复合糖耐量受损组（5．6≤FPG〈7．0mmol／L且7．8≤2hPG〈11．1mmol／L，79例）。进行组间冠心病危险因素和冠状动脉病变程度比较，对FPG、2hPG水平与冠状动脉病变程度进行单因素和多因素分析。结果空腹血糖受损组、糖耐量受损组、复合糖耐量受损组的冠状动脉弥漫性病变、冠状动脉病变总积分、多支病变发生率均高于血糖正常组（P均〈0．05）；尤以复合糖耐量受损组更严重；空腹血糖受损、糖耐量受损两组间冠状动脉弥漫性病变、冠状动脉病变总积分、多支病变发生率无差异（P均〉0．05）。2hPG与冠状动脉病变支数（r=0．437；P〈0．05）、冠状动脉病变Gensini积分（r=0．516；P〈0．05）呈正相关。FPG与冠状动脉病变支数（r=0．397；P〈0．05）、冠状动脉病变Gensini积分（r=0．435；P〈0．05）呈正相关。多元逐步回归分析显示2hPG与冠状动脉病变支数（B=0．357，P〈0．05）、冠状动脉病变总积分（β=0．367，P〈0．05）独立相关。FPG与冠状动脉病变支数（（β=0．308，P〈0．05）、冠状动脉病变总积分（β=0．293，P〈0．05）独立相关。结论IGT、IFG与冠状动脉粥样硬化密切相关，加重冠状动脉病变程度。

Relevance of Blood Glucose Levels and Coronary Artery lesion in the Prediabetic Patients With Coronary Heart Disease

Objective To evaluate the correlation of blood glucose levels with the extent and severity of angiographic coronary artery disease（CAD） in patients in prediabetic period. Methods A total of 386 consecutive patients with angiographi-cally diagnosed CAD were selected in the study. The extent and severity of angiographic CAD were diagnosed by ： whether or not diffuse lesions;the number of diseased vessels;the CAD Gensini cumulative index. According to fasting plasma glucose （FPG） and 2 h plasma glucose（2 h PG） after oral glucose tolerance test （OGTF） ,all patients were stratified into four groups：group 1 ：FPG 〈 5.6mmol/L and 2 h PG 〈 7.8 retool/L; group 2：5.6 ≤ FPG 〈 7.0 mmol/L and 2 h PG 〈 7. 8 mmol/L ; group 3 ： FPG 〈 5.6mmoL/L and 7.8 ≤2 h PG 〈 11.1 mmol/L ; group 4：5.6 ≤ FPG 〈 7.0 mmol/L and 7.8 ≤2 h PG 〈 t 1.1 mmol/L. The CHD risk factors and the lesion degree of coronary arteries were compared among four groups. The relation of FPG,2 h PG and CAD were analyzed by univariate and multivariate analyses. Results Compared with group 1, the incidence of diffuse lesions, the CAD Gensini cumulative index, the incidence of mult-vessel lesions were significantly higher in the other three groups （ all P 〈 0.05 ）, especially group 4. There was no diffence of the incidence of diffuse lesions, the CAD Gensini cumulative index, the incidence of muh-vessel lesions between group 2 and group 3. After adjusting other influencing factors, there were sigoificantly positive correlation between the number of diseased vessels, the CAD Gensini cumulative index and FPG,2 h PG（ all P 〈 0.05）. Conclusion The extent and severity of angiographic coronary artery disease have significant correlations with the impaired glucose tolerance and impaired fasting glucose.