冠心病患者的糖代谢异常分析

目的探讨冠心病患者血糖代谢异常的发生率以及糖代谢异常对心血管事件发生和影响预后的可能机制。方法选择病情稳定的冠心病(NACS)患者和急性冠脉综合征(ACS)患者各110例。抽取静脉血检查空腹血糖(FBG)和餐后2小时血糖(2hPG),若其中任何1项异常,则进行口服葡萄糖耐量试验(OGTT)。根据血糖结果分为糖代谢正常组和糖代谢异常组(包括糖耐量异常组和糖尿病组)。同时行丙二醛(MDA)和超氧化物歧化酶(SOD)测定。结果糖代谢异常发生率在NACS和ACS患者中分别占44.54%和63.64%。无论NACS患者或ACS患者,糖代谢异常组的MDA升高和SOD降低与糖代谢正常组比较差异均有显著性;合并糖尿病和合并糖耐量异常的患者组间MDA及SOD水平比较,差异无显著性。结论糖代谢异常在冠心病患者中发生率较高,其中新识别糖代谢异常需要行OGTT检查;合并糖代谢异常的冠心病患者脂质过氧化程度高;合并糖耐量异常与合并糖尿病一样,对冠心病患者有相等程度的氧化应激。

The abnormal metabolism of the blood glucose in patients with coronary artery disease

Objective To observe the prevalence of abnormal blood glucose metabolism and explore the potential mechanism of influence of glucose abnormality on prognosis in patients with coronary artery disease (NACS).Methods One hundred and ten patients with NACS and 110 patients with acute coronary syndromes (ACS) were enrolled.Oral glucose tolerance test (OGTT) was performed when FBG or 2hPG was abnormal.According to OGTT,all patients were divided into three groups:diabetes mellitus group (DM),impaired glucose tolerance group (IGT) and normal glucose tolerance group (NGT).Malonaldehyde (MDA) and superoxide dismutase (SOD) were determined.Results The incidences of abnormal glucose metabolism were 44.54% and 63.64% in stable NACS patients and in ACS patients respectively.MDA increase and SOD decrease were significantly different between stable NACS patients and ACS patients with abnormal blood glucose metabolism.There were significant differences in MDA (P<0.001) and in SOD (P<0.001) between abnormal glucose metabolism group and NGT group in either stable NACS or ACS patients.The levels of MDA and SOD did not reach statistical difference between DM group and IGT group in patients with ACS (P>0.05).Conclusion Previously undiagnosed abnormal glucose metabolism is very common in patients with stable NACS and ACS and can be easily disclosed by OGTT.The patients with glucose abnormalities have more strengthened oxidative stress than those with NGT.Both IGT and DM may be risk factors of cardiovascular events through similar oxidative stress mechanism.