2型糖尿病合并冠心病患者冠脉病变与糖化血红蛋白水平的关系

目的探讨2型糖尿病（T2DM）合并冠心病（CAD）患者糖化血红蛋白（HbA1c）水平与冠脉病变特点的关系。方法 289例T2DM合并CAD患者,按照HbA1c水平分为两组,A组103例（HbA1c〈7%）,B组186例（HbA1c≥7%）,对两组患者冠脉造影结果进行Gensini积分并对比分析。结果 B组患糖尿病史、吸烟比例和微量白蛋白尿阳性率均高于A组,空腹血糖、总胆固醇、甘油三酯、血尿酸水平也高于A组;从冠脉病变看,三支病变、弥漫性病变、冠脉C型病变,B组显著高于A组,且B组冠脉病变Gensini积分较高（P〈0.01）,HbAlc水平与Gensini积分呈正相关（P〈0.01）。结论 T2DM合并CAD患者HbAlc水平高,其冠脉病变呈现复杂和严重的临床特点。因此,T2DM合并CAD患者应尽早积极有效地控制血糖水平,对于冠心病的防治甚为重要。

The relationship between HbA1c and angiographic characteristics of coronary artery disease in patients with type 2 diabetes

Objective To investigate the relationship between HbA1c and the angiographic characteristics of coronary artery disease（CAD）in patients with type 2 diabetes.Methods A total of 289 patients with type 2 diabetes combined CAD were divided into two groups according to the level of HbA1c.One hundred and three patients were in group A with HbA1c7% and 186 patients in group B with HbA1c≥7%.The angiographic characteristics of coronary artery among them were analyzed and the Gensini score were compared between the two groups.Results The ratio of type 2 diabetes,positive microalbuminuria（Malb）and smoking were higher in group B,and the level of glucose,cholesterol,triglyceride and uric acid were higher in group B（all P0.05）.The patients in group B had more three branches disease and type C coronary artery disease（P0.05）.The angiographic characteristics were more extensive and the Gensini scores in group B were higher than those in group A（49.42±34.60 vs 39.14±27.83,P0.01）,and the level of HbA1c was positively correlated to Gensini score in all the patients（P0.01）.Conclusions HbA1c is an independent risk factor in patients with type 2 diabetes combined coronary artery disease,and well control of glucose is critical for the treatment of CAD.