合并各类危险因素的2型糖尿病患者冠状动脉病变影像学特征

背景随着2型糖尿病患病率的上升,人们应重视其心血管并发症的早期干预,以降低其并发症的发病率.目的观察 2型糖尿病合并冠心病危险因素及冠状动脉造影情况. 设计以患者为研究对象,横断面的观察对比研究.单位一所市级医院的内科病房. 对象实验于 1998- 05/2003- 05在哈尔滨市第一医院内分泌科完成.纳入标准符合1997年 ADA确定的糖尿病诊断标准及 1979年 WHO制定的<缺血性心脏病的命名和诊断标准>的大于30岁的 2型糖尿病合并冠心病患者;排除标准患有严重心、肝、肾疾病及严重的感染,风湿性心脏病、肺源性心脏病者.98例住院患者符合上述纳入标准,设为糖尿病组,男 56 例,女 42例,年龄为35～ 70岁.对照组为同期住院的非糖尿病冠心病患者 85例,男 53 例,女 32例,年龄为40～ 75岁. 方法观察血糖(葡萄糖氧化酶法)、空腹胰岛素和 C肽(放免法)、糖化血红蛋白(亲和层析微柱法)血清三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇(全自动生化仪)及应用JUDKINS方法行选择性左右冠状动脉造影. 主要观察指标① 2组冠状动脉造影结果比较;②糖尿病病程与冠状动脉病变支数关系的比较.结果 2组冠状动脉造影结果比较 ,糖尿病组的左主干病变、回旋支病变者与对照组相比,差异无显著性意义(P >0.05);而前降支和右冠状动脉的病变者糖尿病组多于对照组( P<0.05),并且糖尿病组的病变表现为 3支病变和单支病变为主,呈现为弥漫性改变.2型糖尿病患者的冠状动脉病变多数是 3支血管病变,其病变弥漫,且随病程越长,越易发生多支血管病变.结论 2型糖尿病患者随着病程的延长,冠心病的发生逐渐增多,且病变范围广,病情较严重.

Features of coronary angiography in type 2 diabetic patients combining various risk factors

BACKGROUND:With the increasing morbidity of type 2 diabetes, people should pay more attention to the early intervention of cardiovascular complications in order to reduce the incidence of its complications. OBJECTIVE:To observe the risk factors of type 2 diabetes combining coronary heart disease(CHD) and the images of coronary angiography. DESIGN:A cross-sectional observational study. SETTING:Internal medicine department of a municipal hospital. PARTICIPANTS:The study was completed in the Department of Endocrine Harbin First Hospital from May 1998 to May 2003.Inclusive criteria:Type 2 diabetic patients aged above 30 years old and combined with CHD with either sex, who met the diagnostic standard of diabetes set by ADA in 1997 and Naming and Diagnostic standard of ischemic heart disease set by WHO in 1979. Exclusive criteria:Patients suffering from severe heart,liver,kidney disease and serious infection,rheumatoid heart disease,pulmonary heart disease and so on.There were 98 inpatients, who met the above mentioned inclusive criteria, were set as the diabetic group with 56 males and 42 females,aged from 35 to 70 years old;and 85 CHD patients without combining diabetes admitted to hospital at the same time were chosen as the control group with 53 males and 32 females, aged from 40 to 75 years old. INTERVENTIONS:The blood glucose was observed with the glucose oxidase method,fasting insulin and C peptide with radioimmunoassay (RIA),glycosylated hemoglobin with affinity chromatography, triglyceride(TG),total cholesterol(TC),high density lipoprotein-cholesterol(HDL-C) and low density lipoprotein-cholesterol (LDL-C) with automatic biochemical analysis,and selective right coronary angiography was applied by JUDKINS method. Of coronary arteries. RESULTS:The comparison of the coronary angiographic images between the two groups showed that there was no significant difference in the lesion of left main trunk and circumflex artery between the diabetic group and control group(P >0.05);While there were more cases with lesion of anterior descending artery and right coronary artery in the diabetic group than in the control group(P< 0.05). The pathological changes in the diabetic group mainly manifested with lesion of three branches and single branch in which represented diffusive changes.Lesion of three branches was the main pathological change of coronary artery in type 2 diabetic patients with diffusive changes. CONCLUSION:With the extension of course of type 2 diabetes in patients,the incidence of CHD will gradually increase with extensive pathological changes and much severe conditions.