急性冠脉综合征患者空腹血糖及糖化血红蛋白与冠状动脉病变程度的相关性

目的 探讨急性冠脉综合征(ACS)患者空腹血糖(FPG)及糖化血红蛋白(HbA1c)与冠状动脉病变严重程度的相关性。方法 回顾性分析2019年10月至2020年10月中国人民解放军东部战区总医院心血管内科收治的166例ACS患者的临床资料,应用Gensini评分评估患者冠状动脉病变的严重程度,根据Gensini评分将冠状动脉病变程度分为轻度、中度及重度狭窄组。分析FPG及HbA1c与ACS患者冠状动脉病变程度的相关性。采用 SPSS 19.0 统计软件进行数据分析。采用Spearman及偏相关进行相关性分析。采用logistic 回归分析重度冠状动脉狭窄的危险因素。结果 轻度、中度及重度冠状动脉狭窄组FPG与HbA1c比较,差异有统计学意义(均P<0.05)。 Spearman相关性分析(r=0.331,P<0.001)及偏相关性分析(r=0.379,P<0.001)均显示FPG与Gensini评分呈正相关,Spearman相关性分析中HbA1c与Gensini评分无明显相关性(P=0.096)；控制相关影响因素行偏相关分析,HbA1c与Gensini评分呈正相关(r=0.191,P=0.049)。logistic回归分析显示FPG和HbA1c均是ACS患者发生重度冠状动脉狭窄的独立危险因素(均P<0.05)。受试者工作特征曲线显示,FPG和HbA1c预测冠状动脉发生重度狭窄的曲线下面积分别是0.637和0.581,FPG=7.0mmol/L预测的灵敏度和特异度分别为46.0%和86.6%；HbA1c=6.0%预测的灵敏度和特异度分别为56.4%和62.5%,两者的预测价值无明显差异(P=0.534)。结论 FPG和HbA1c均是影响冠状动脉病变程度的独立危险因素,两者对重度冠状动脉病变发生的预测价值无明显差异。

Correlation of fasting plasma glucose and HbA1c with severity of coronary artery lesion in acute coronary syndrome

Objective To investigate the correlation of fasting plasma glucose(FPG) and glycated hemoglobin A1c(HbA1c)with the severity of coronary artery lesion in the patients diagnosed with acute coronary syndrome (ACS). Methods A retrospective analysis was made of 166 ACS patients admitted to the Department of Geriatrics of the Chinese PLA General Hospital of Eastern Theater Command. According to the degree of coronary artery lesion on Gensini assessment, the patients were divided into mild, moderate and severe stenosis groups. An analysis was made of the correlation of FPG and HbA1c with the degree of coronary artery lesion. SPSS statistics 19.0 was employed for data analysis. Spearman and partial correlation were used for correlation analysis. Logistic regression was performed to analyze the risk factors of severe coronary artery stenosis. Results FPG and HbA1c differed significantly between patients with mild, moderate and severe coronary stenosis (P<0.05). Spearman correlation analysis (r=0.331, P<0.001) and partial correlation analysis (r=0.379, P<0.001) showed that FPG was positively correlated with Gensini score, there was no significant correlation between HbA1c and Gensini score in Spearman correlation analysis (P=0.096), but HbA1c had correlation with Gensini score (r=0.191, P=0.049) performed by partial correlation analysis after controlling related factors. Logistic regression analysis showed that both FPG and HbA1c were independent risk factors for severe coronary stenosis in ACS patients (P<0.05). The area under receiver operating characteristic curve of FPG and HbA1c for predicting severe coronary stenosis were 0.637 and 0.581, respectively, with a sensitivity of 46.0% and a specificity of 86.6% for FPG=7.0 mmol/L, and with a sensitivity of 56.4% and a specificity of 62.5% for HbA1c=6.0%. There was no significant difference in the predictive value of the two indexes (P=0.534). Conclusion FPG and HbA1c are independent risk factors for the degree of coronary artery lesion without significant difference in predicting the occurrence of severe coronary artery lesion.