糖耐量受损对冠心病患者近期及远期预后的影响
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摘要
目的通过探讨糖耐量受损对于冠心病患者近期及远期预后的影响,明确早期评估患者糖耐量水平对于冠心病患者管理的重要性。方法通过糖尿病病史及口服糖耐量试验(OGTT)结果,将878例冠心病患者分为血糖正常组(n=240)、空腹血糖受损(IFG)组(n=115),糖耐量受损(IGT)组(n=204)、糖尿病(DM)组(n=319),观察一个月内各组心肌梗死、再次血运重建、全因死亡等主要心血管不良事件(MACE)发生情况。随访30天后存活患者,定期电话或临床随访患者远期预后情况。结果与血糖正常组相比,IGT组和DM组30天内的非致命心梗(3.75%对11.76%和12.54%;P<0.05,P<0.01)、再次血运重建(1.67%对4.9%和5.01%;P均<0.05)、全因死亡(2.5%对9.31%和10.97%;P<0.05,P<0.01)及MACE(7.92%对25.49%和28.53%;P<0.05,P<0.01)发生率均显著增高。远期预后结果显示,与血糖正常组相比,IGT组和DM组再次血运重建(18.88%对35.52%和32.38%;P均<0.01)、全因死亡(2.58%对8.20%和10.32%;P均<0.01)及MACE事件(25.75%对50.27%和51.96%;P均<0.01)的发生率均显著增高;DM组的非致命性心梗发生率亦较血糖正常组显著增高(9.25%对4.25%,P<0.05)。IGT组与DM组临床预后情况相似(P>0.05)。结论冠心病患者中合并IGT者心血管事件发生率与合并DM者相似,其近期及远期预后较血糖正常者差。
Objective To investigate the influence of impaired glucose tolerance on short-term and long-term prognosis in Patients with coronary heart disease.Methods A total of 878 patients with Coronary Heart Disease were divided into 4 groups according to history of diabetes mellitus and results of oral glucose tolerance test(OGTT):normal plasma glucose group(n=240),impaired fasting glucose(IFG)group(n=115),impaired glucose tolerance(IGT)group(n=204),and diabetes mellitus(DM)group(n=319).30 days event rate was recorded.All the alive patients(after 30 days)have been followed up for long-term prognosis.Results Compared with normal plasma glucose group,the 30 days event rates of myocardial infarction(3.75% vs.11.76% and 12.54%;P<0.05,P<0.01),revascula-rization(1.67% vs.4.9% and 5.01%;all P<0.05),deathclinical(2.5% vs.9.31% and 10.97%;P<0.05,P<0.01)and MACE(7.92% vs.25.49% and 28.53%;P<0.05,P<0.01)were significantly higher in DM and IGT groups.In the comparison of long-term prognosis,compared with normal plasma glucose group,the incidences of revascula-rization(18.88% vs.35.52% and 32.38%;all P<0.01),deathclinical(2.58% vs.8.20% and 10.32%;all P<0.01)and MACE(25.75% vs.50.27% and 51.96%;all P<0.01)were significantly higher in DM and IGT groups.There was no statistical significance in the short-term and long-term prognosis between IGT group and DM group(P>0.05).Conclusion CHD patients with IGT or DM have poorer short-term and long-term prognosis than whom with normal plasma glucose.
Objective To investigate the influence of impaired glucose tolerance on short-term and long-term prognosis in Patients with coronary heart disease.Methods A total of 878 patients with Coronary Heart Disease were divided into 4 groups according to history of diabetes mellitus and results of oral glucose tolerance test(OGTT):normal plasma glucose group(n=240),impaired fasting glucose(IFG)group(n=115),impaired glucose tolerance(IGT)group(n=204),and diabetes mellitus(DM)group(n=319).30 days event rate was recorded.All the alive patients(after 30 days)have been followed up for long-term prognosis.Results Compared with normal plasma glucose group,the 30 days event rates of myocardial infarction(3.75% vs.11.76% and 12.54%;P<0.05,P<0.01),revascula-rization(1.67% vs.4.9% and 5.01%;all P<0.05),deathclinical(2.5% vs.9.31% and 10.97%;P<0.05,P<0.01)and MACE(7.92% vs.25.49% and 28.53%;P<0.05,P<0.01)were significantly higher in DM and IGT groups.In the comparison of long-term prognosis,compared with normal plasma glucose group,the incidences of revascula-rization(18.88% vs.35.52% and 32.38%;all P<0.01),deathclinical(2.58% vs.8.20% and 10.32%;all P<0.01)and MACE(25.75% vs.50.27% and 51.96%;all P<0.01)were significantly higher in DM and IGT groups.There was no statistical significance in the short-term and long-term prognosis between IGT group and DM group(P>0.05).Conclusion CHD patients with IGT or DM have poorer short-term and long-term prognosis than whom with normal plasma glucose.
引文
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[9]吴茂红,吕玲.糖耐量异常对冠心病患者氧化应激和血管内皮功能、心率变异性的影响及阿卡波糖的干预作用[J].中国动脉硬化杂志,2014,22(3):287.
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[11]李旭东,黄宜杰.冠心病合并高胰岛素血症患者血浆内皮素与冠脉病变关系的研究[J].中国当代医药,2009,16(23):37.
[12]杨红年,金学林,张玲,等.IL-10与2型糖尿病合并冠心病患者关系的研究[J].宁夏医学杂志,2015,37(4):313.
[2]Bartnik M,Malmberg K,Norbammar A,et al.Newly detected abnormal glucose tolerance:an important predictor of long-term outcome after myocardial infarction[J].Eur Heart J,2004,25(22):1990.
[3]Hash imoto K,Ikew aki K,Yagi H,et al.Glucose in tolerance is common in Japanese patients with acute coronary syndrome who were not previously diagnosed with diabetes[J].Diabetes Care,2005,28:1182.
[4]Choi KM,Lee KW,K im SG,et al.In flammation,insulin resistance,and glucose in tolerance in acute myocardial in farction patients without a previous diagnosis of diabetes mellitus[J].J Clin Endocrinol Metab,2005,90:175.
[5]World Health Organization Difinition,Diagnosis and classification of diabtes mellitus and its complications:report of a WHO on sultation Part1Diagnosis and classification of diabtes mellitus Geneva,World Health Organization,1999.
[6]心血管内科糖代谢异常早期筛查及管理专家组.心血管内科糖代谢异常早期筛查及管理专家共识[J].中华内科杂志,2012,51(7):574.
[7]Sourij H,Saely CH,schmid F,et al.Post-challenge hyperglycaemia is strongly associated with future macrovascular events and total mortality in angiograPhied coronary patients[J].Eur Heart J,2010,31(13):1583.
[8]Tamita K,Katayama M,Takagi T,et al.Newly diagnosed glucose intolerance and prognosis after acute myocardial infarction:comparison of post-challenge versus fasting glucose concentrations[J].Heart,2012,98(11):848.
[9]吴茂红,吕玲.糖耐量异常对冠心病患者氧化应激和血管内皮功能、心率变异性的影响及阿卡波糖的干预作用[J].中国动脉硬化杂志,2014,22(3):287.
[10]徐锐.巨噬细胞移动抑制因子基因多态性与冠心病关联性研究新进展[J].心血管病学进展,2014,35(1):71.
[11]李旭东,黄宜杰.冠心病合并高胰岛素血症患者血浆内皮素与冠脉病变关系的研究[J].中国当代医药,2009,16(23):37.
[12]杨红年,金学林,张玲,等.IL-10与2型糖尿病合并冠心病患者关系的研究[J].宁夏医学杂志,2015,37(4):313.