老年冠心病患者糖代谢异常及胰岛素抵抗调查

目的对既往未诊断糖尿病（DM）的住院老年冠心病患者进行糖代谢及胰岛素抵抗情况的调查,并对不同糖代谢状况患者的糖化血红蛋白（HbA1c）和24 h尿蛋白定量进行比较分析,为以后的临床干预打下基础。方法 356例老年冠心病患者,年龄均在60岁以上,空腹抽血查空腹血糖、胰岛素、HbA1c。行简化糖耐量试验（OGTT）,查餐后2 h血糖。留24 h尿进行尿蛋白定量。根据2003年美国糖尿病协会（ADA）标准判断患者的糖代谢状况,计算糖代谢异常者的比率。对不同糖代谢状况的患者进行血糖、胰岛素、HbA1c和24 h尿蛋白量比较。结果 356例既往未诊断DM的老年冠心病病人中,新发现DM 26例,占总观察数的7.3%,发现糖调节受损（IGR）61例,总的糖代谢异常发生率达25.0%。不同糖代谢状态的病人其空腹血糖和餐后2 h血糖的水平存在明显差异（P〈0.05或P〈0.01）。正常糖代谢（NG）组空腹胰岛素低于IGR组和DM组,同时胰岛素抵抗指数（HOMA-IR）也低于其他两组,而β细胞功能指数（HOMAβ）则高于糖代谢异常组（P〈0.01）。而DM组的空腹胰岛素水平、HOMA-IR、HOMAβ也和IGR组比较差异有统计学意义（P〈0.01）。糖代谢正常的老年冠心病患者的HbA1c和另两组的患者比较差异有统计学意义（P〈0.01）,而IGR组和DM组患者也有差别（P〈0.05）。24 h尿蛋白量在3组间比较差异有统计学意义（P〈0.01）。结论在老年冠心病患者中有较高的糖代谢异常发生率。糖代谢异常患者的胰岛素抵抗也较糖代谢正常的患者明显,HOMAβ下降。部分病人的高血糖状态已持续较长时间,有些患者已有早期肾功能的改变。

Survey on glycometabolic disorders and insulin resistance in aged Coronary-Heart-Disease(CHD)sufferers

Objective To investigate insulin resistance and abnormal glucose metabolism in elderly patients with coronary heart disease,and glycosylated hemoglobin and 24-hour urinary protein were compared between patients of different glucose metabolism,so accesses the necessity of intervention.Methods 356 elderly patients with CHD without knowing diabetes were recruited.FPG,2 h PG,HbA1c,24-hour urinary protein were measured,HOMA-IR,HOMA β were calculated,then obtained the rate of abnormal glucose metabolism.All these patients were divided into three groups according to blood glucose levels,and their FPG,2 h PG,HOMA-IR,HOMA,HbA1c,24-hour urinary protein were compared.Results Total 356 cases of elderly coronary heart disease patients,all undiagnosed diabetes before,26 patients with newly discovered diabetes which is 7.3% of the total number,and found 61 cases of impaired glucose regulation,the overall rate of abnormal glucose metabolism is 25.0%.Patients with various glucose state had significant different of FPG,2 h PG levels（P0.05 or P0.01）.Normal glucose metabolism patients,their FINS,as well as insulin resistance index,were below the IGR group and the DM group,while the β-cell function index were higher than those of abnormal glucose metabolism group（P0.01）.The fasting insulin,insulin resistance index,β-cell function index of DM group were significantly different（P0.01）with those of IGR group.Glycosylated hemoglobin,24-hour urine protein excretion compared among three groups were also significant ly different（P0.05 or P0.01）.Conclusion Patients with coronary heart disease have a higher incidence of abnormal glucose metabolism.Abnormal glucose metabolism patients have insulin resistance and β-cell function depression.The glycated hemoglobin results show some patients have sustained high glucose for a long time.24-hour urine protein excretion results show some patients even have early renal functional changes.