糖尿病并发冠心病危险因素分析
摘要
目的:研究糖尿病及糖尿病并发冠心病患者血脂、血糖及血栓形成指标水平的变化。方法:采用病例对照研究的方法对40例糖尿病、40例糖尿病并发冠心病及40例冠心病患者的血脂、糖化血红蛋白(HbA_1c)、糖尿病病程、体重指数(BMI)、血栓形成指标进行比较。结果:1.三组间,糖尿病并发冠心病组高密度脂蛋白-胆固醇(HDL-C)水平明显低于糖尿病组,D-二聚体水平明显高于糖尿病组(P＜0.05)。2.糖尿病组的BMI明显高于糖尿病并发冠心病组,但明显低于冠心病组(P＜0.05)。3.三组间,低密度脂蛋白-胆固醇(LDL-C)、纤维蛋白原(FBG)水平存在一定差异,但差异无显著性;糖尿病组和糖尿病并发冠心病组间HbA_1c和糖尿病病程存在一定差异,但差异无显著性。结论:糖尿病患者存在血脂代谢紊乱及血栓形成等危险因素,糖尿病患者、糖尿病并发冠心病患者与冠心病患者的血脂代谢紊乱、D-二聚体水平有所不同。
Objective To investigate the changes of lipid level,serum glucose, thrombogenesis index of patients with diabetes mellitus and patients complicated with coronary artery disease.Method We compared lipid level,HbA_1c,the course of diabetes mellitus,BMI,D-dimer level of 40 patients with diabetes mellitus,40 patients with diabetes mellitus complicated with coronary artery disease and 40 patients with coronary artery disease by ease control study.Results 1.Among the three groups,the HDL-C level of group with diabetes mellitus complicated with coronary artery disease was significantly lower than that of group with diabetes mellitus(P＜0.05),while D-dimer level was significantly higher than that of group with diabetes mellitus(P＜0.05);The BMI of group with diabetes mellitus was significantly higher than that of group with diabetes mellitus complicated with coronary artery disease and significantly lower than the group with coronary artery disease(P＜0.05). The LDL-C level and fibrinogen level of three group were no significant differences.The course and HbA_1c between group with diabetes mellitus and group with diabetes mellitus complicated coronary artery disease were no significant differences.Conclusion There are risk factors of lipid metabolic disorder and thrombogenesis etc.in patients with diabetes mellitus.Lipid metabolic disorder and D-dimer level of patients with diabetes mellitus,patients with diabetes mellitus complicated with coronary artery disease and patients with coronary artery disease are different.
Objective To investigate the changes of lipid level,serum glucose, thrombogenesis index of patients with diabetes mellitus and patients complicated with coronary artery disease.Method We compared lipid level,HbA_1c,the course of diabetes mellitus,BMI,D-dimer level of 40 patients with diabetes mellitus,40 patients with diabetes mellitus complicated with coronary artery disease and 40 patients with coronary artery disease by ease control study.Results 1.Among the three groups,the HDL-C level of group with diabetes mellitus complicated with coronary artery disease was significantly lower than that of group with diabetes mellitus(P＜0.05),while D-dimer level was significantly higher than that of group with diabetes mellitus(P＜0.05);The BMI of group with diabetes mellitus was significantly higher than that of group with diabetes mellitus complicated with coronary artery disease and significantly lower than the group with coronary artery disease(P＜0.05). The LDL-C level and fibrinogen level of three group were no significant differences.The course and HbA_1c between group with diabetes mellitus and group with diabetes mellitus complicated coronary artery disease were no significant differences.Conclusion There are risk factors of lipid metabolic disorder and thrombogenesis etc.in patients with diabetes mellitus.Lipid metabolic disorder and D-dimer level of patients with diabetes mellitus,patients with diabetes mellitus complicated with coronary artery disease and patients with coronary artery disease are different.
引文
[1]Stratton IM,Adler AI.Nell HA.Association of glycaemia with nlacrovascuiar and microvascular complications of type 2 diabetes:UKPDS(35)[J].BMJ,2000.321(7258):405-412.
[2]Madigan C,Ryan M,Owens D,et al.Comparison of diets high in monounsaturated versus polyunsaturated fatty acid on postprandial lipoproteins in diabetes[J].Ir J Med Sci.2005.174(1):8-20.
[3]陶军,周舸,等.高甘油三酯血症对动脉弹性功能的影响[J].心脑血管病防治,2003,3(4):19.
[4]Howard B V,Robbins D C,Sievers M L,et al.LDL cholesterol as a strong predictor of coronary heart disease in diabetic individuals with insulin resistance and low LDL:the Strong Heart Study[J].Arterioscler Thromb Vasc Biol,2000,20(30):830.
[5]DECODE-Study Group.Post-challenge hyperglycaemia rather than fasting hyperglycaemia is an independent risk factor of cardiovascular disease events[J].Clin Lab,2004,50(9):609-615.
[6]胡绍文,郭瑞林.实用糖尿病学[M].北京:人民军出版社, 1998,211-213.
[7]Freemn D,Norrie J,Caslake M J,et al.Creactive protein is an independent predictor of risk for the development of diabetes in west of Scotland cornary prevention study[J].Diabetes,2002,51:1596-1600
[8]Maroaca G,Blasio AD,Marchioli R,et al.Measuring plasma fibrinogento predict stroke and myocardial infarction an update.Arterioscler Thromb Vasc Biol.1999 Jun;19(6):1368-77.
[9]杨文英.陈晓平,杨兆军等.不同BMI水平对血糖、血脂及血压的影响[J].中国糖尿病杂志.2001.9(5):275-278.
[10]Mak KH,Moliterno DJ,Granger CB,et al.Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction.GUST0-I Investigators.Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.J Am Coll Cardiol,1997,30:171-179.
[11]Goraya TY,Leibson CL,Palumbo PJ,et al.Coronary atherosclerosis in diabetes mellitus:a population-based autopsy study.J Am Coil Cardiol.2002,40:946-953.
[12]Ledru F,Ducimetiere P,Battaglia S,et al.New Diagnostic Criteria for Diabetes and Coronary Artery Disease:Insights from an Angiographic Study.J Am Coll Cardiol,2001,37:1543-1550.
[1]Expert Panel on Detection.Evaluation。and Treatment of High Blood Cholesterol in Adults.Executive summary of the third report of The National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol In Adults(Adult Treatment Panel Ⅲ).JAMA,2001,285:2486-2497.
[2] Stratton IM , Adler AL Nell HA. Association of glycaemia with nlacrovascuiar and microvascular complications of type 2 diabetes: UKPDS(35)[J]. BMJ, 2000. 321(7258):405-412.
[3] Zhang YF, Hong J, Zhan WW, et al. Hyperglycaemia after glucose loading is a major predictor of preclinical atherosclerosis in nondiabetic subjects [J].Clin Endocrinol(Oxf),2006,64(2):153-157.
[4] DECODE-Study Group. Post-challenge hyperglycaemia rather than fasting hyperglycaemia is an independent risk factor of cardiovascular disease events[J].Clin Lab,2004,50(9):609-615.
[5] Adler AI, Stratton IM , Nell HA. et al. Association of systolic blood pressure with macrovacular and microvascular complications of type 2 diabetes: UKPDS (36)[J].BMJ, 2000,321(7258):412-419.
[6] Dandona P, Aljada A, Mohanty P, et al. Insulin inhibits intranuclear nuclear factor kB and stimulates I kB in mononuclear cells in obese subjects: evidence for an anti-inflammatory effect? J Clin Endocrinol Metab,2001,86:3257-3265.
[7] Haffner SM, Alexander CM , Cook TJ, et al. Reduced coronary event in simvastatin treated patients with coronary heart disease and diabetes of impaired fasting ucose levels.Arch Internmed, 1999,159: 2661-2667.
[8]Madigan c, Ryan M, Owens D, et al. Comparison of diets high in monounsaturated versus polyunsaturated fatty acid on postprandial lipoproteins in diabetes[J].Ir J Med Sci.2005.174(1):8-20.
[9]Anderson RA.Evans ML.Ellis GR.et al.The relationships between postprandial lipaemia,endothelial function and oxidative stress in healthy individuals and patients with type 2diabetes[J].Atherosclerosis,2001.154(2):475-483.
[10]Varughese GI,Tomson J,Lip GY.Type 2 diabetes mellitus:a cardiovascular perspective[J].Int J Clin Pract,2005,59(7):798-816.
[11]Evans JL,GoldfineID,Maddux BA,et al.Oxidative stress and stress-activated signaling pathways:a unifying hypothesis of type 2diabetes.EndocrRev,2002,23:599-622.
[12]黄敬泽,王健,张闽珍,等.血管内皮细胞损伤在2型糖尿病血管病变中的意义[J].中华内分泌代谢杂志,2000,16(3):169-171.
[13]Yu Y.Lyons TJ.A lethal tetrad in diabetes:hyperglycemia,dyslipidemia,oxidative stress,and endothelial dysfunction[J].Am J Med Sci,2005,330(5):227-232.
[14]M,Egberg N,Wamala S,Orth-Gomer K,Mittleman MA,Schenck-Gustafsson K.Relationship between plasma fibrinogen and coronary heart disease in women.Arterioscler Thromb Vasc Biol.1999 Jan;19(1):67-72.
[15]Fowkes FG;Lowe GD,Connor JM,Rumley A.Fibrinogen,factor Ⅶ and PAI-1 genotypes and the risk of coronary and peripheralatherosclerosis:Edinburgh Artery Study.Thromb Haemost. 1999 Apr;81(4):553-60.
[16]Sato S, Nakamura M, Iida M, Naito Y, Kitamura A, Okamura T, Nakagawa Y, Imano H, Kiyama M, Iso H, Shimamoto T, Komachi Y. Plasma fibnnogen and coronary heart disease in urban Japanese. Am J Epidemiol. 2000 Sep 1;152(5):420-3.
[17]Maroaca G, Blasio AD, Marchioli R, et al. Measuring plasma fibrinogento predict stroke and myocardial infarction an update. ArteriosclerThromb Vasc Biol. 1999 Jun; 19(6): 1368-77.
[18]Wong TY. Szeto CC. Chow KM, et al. Contribution of gene polymorphisms in the rennin-angiotensin system to macroangiopathy in patients with diabetic nephropathy[J]. Am J Kidney Dis, 2001; 38(1): 9-17.
[19]Jandeleit-Dahm K, Cooper ME. Hypertension and diabetes: role of the renin-angiotensin system [J]. Endocrinol Metab Clin North Am, 2006,35(3): 469-490.
[20]Haidari M , Javadl E, Sadeghi B, et al. Evaluation of C reactive protein, a sensitive marker of inflammation, as a risk factor for stable coronary artery disease[J]. Clin Biochemo 2001. 34(4):309—312
[21]Vincenzo P, James TW, Edward THY. Direct Proinflammatory Effect of C-Reactive Protein on Human Endothelia Cells[J]. Circulation, 2000, 102: 2165-2168.
[22]Sridevid D, Dan Y X, Ishwarlal J. C-Reactive Protein Increases Plasminogen Activator Inhibitor-1 Expression and Activity in Human Aortic Endothelial Cells:Implications for the Metabolic Syndrome and Atherothrombosis[J].Circulation,2003,107:398-404.
[23]Anderas F,Rash DA Jr,George GE,et al.Chronic Subclinical Infammafion as Part of the Insulin Resistance Syndrome..The Insulin Resistance Atherosclerosis Study(IRAS)[J].Circulation,2000,102:42-47.
[24]Paul M,Ridker MD.Nader R,et.Comparison of C-reactive protein and low-density lipopmtein cholesterol levels in the prediction of first cardiovacular events.N Eng J Med,2002,347(20):1557-1560.
[25]Bramlage P,Wittchen HU,Pittrow D.et al.Microalbuminuria is an early marker for increased morbidity and mortality[J].Fortschr Med Orlg,2003,121(Suppl 1):28-32.
[26]杨文英.陈晓平,杨兆军,等.不同BMI水平对血糖、血脂及血压的影响[J].中国糖尿病杂志.2001,9(5):275-278.
[2]Madigan C,Ryan M,Owens D,et al.Comparison of diets high in monounsaturated versus polyunsaturated fatty acid on postprandial lipoproteins in diabetes[J].Ir J Med Sci.2005.174(1):8-20.
[3]陶军,周舸,等.高甘油三酯血症对动脉弹性功能的影响[J].心脑血管病防治,2003,3(4):19.
[4]Howard B V,Robbins D C,Sievers M L,et al.LDL cholesterol as a strong predictor of coronary heart disease in diabetic individuals with insulin resistance and low LDL:the Strong Heart Study[J].Arterioscler Thromb Vasc Biol,2000,20(30):830.
[5]DECODE-Study Group.Post-challenge hyperglycaemia rather than fasting hyperglycaemia is an independent risk factor of cardiovascular disease events[J].Clin Lab,2004,50(9):609-615.
[6]胡绍文,郭瑞林.实用糖尿病学[M].北京:人民军出版社, 1998,211-213.
[7]Freemn D,Norrie J,Caslake M J,et al.Creactive protein is an independent predictor of risk for the development of diabetes in west of Scotland cornary prevention study[J].Diabetes,2002,51:1596-1600
[8]Maroaca G,Blasio AD,Marchioli R,et al.Measuring plasma fibrinogento predict stroke and myocardial infarction an update.Arterioscler Thromb Vasc Biol.1999 Jun;19(6):1368-77.
[9]杨文英.陈晓平,杨兆军等.不同BMI水平对血糖、血脂及血压的影响[J].中国糖尿病杂志.2001.9(5):275-278.
[10]Mak KH,Moliterno DJ,Granger CB,et al.Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction.GUST0-I Investigators.Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.J Am Coll Cardiol,1997,30:171-179.
[11]Goraya TY,Leibson CL,Palumbo PJ,et al.Coronary atherosclerosis in diabetes mellitus:a population-based autopsy study.J Am Coil Cardiol.2002,40:946-953.
[12]Ledru F,Ducimetiere P,Battaglia S,et al.New Diagnostic Criteria for Diabetes and Coronary Artery Disease:Insights from an Angiographic Study.J Am Coll Cardiol,2001,37:1543-1550.
[1]Expert Panel on Detection.Evaluation。and Treatment of High Blood Cholesterol in Adults.Executive summary of the third report of The National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol In Adults(Adult Treatment Panel Ⅲ).JAMA,2001,285:2486-2497.
[2] Stratton IM , Adler AL Nell HA. Association of glycaemia with nlacrovascuiar and microvascular complications of type 2 diabetes: UKPDS(35)[J]. BMJ, 2000. 321(7258):405-412.
[3] Zhang YF, Hong J, Zhan WW, et al. Hyperglycaemia after glucose loading is a major predictor of preclinical atherosclerosis in nondiabetic subjects [J].Clin Endocrinol(Oxf),2006,64(2):153-157.
[4] DECODE-Study Group. Post-challenge hyperglycaemia rather than fasting hyperglycaemia is an independent risk factor of cardiovascular disease events[J].Clin Lab,2004,50(9):609-615.
[5] Adler AI, Stratton IM , Nell HA. et al. Association of systolic blood pressure with macrovacular and microvascular complications of type 2 diabetes: UKPDS (36)[J].BMJ, 2000,321(7258):412-419.
[6] Dandona P, Aljada A, Mohanty P, et al. Insulin inhibits intranuclear nuclear factor kB and stimulates I kB in mononuclear cells in obese subjects: evidence for an anti-inflammatory effect? J Clin Endocrinol Metab,2001,86:3257-3265.
[7] Haffner SM, Alexander CM , Cook TJ, et al. Reduced coronary event in simvastatin treated patients with coronary heart disease and diabetes of impaired fasting ucose levels.Arch Internmed, 1999,159: 2661-2667.
[8]Madigan c, Ryan M, Owens D, et al. Comparison of diets high in monounsaturated versus polyunsaturated fatty acid on postprandial lipoproteins in diabetes[J].Ir J Med Sci.2005.174(1):8-20.
[9]Anderson RA.Evans ML.Ellis GR.et al.The relationships between postprandial lipaemia,endothelial function and oxidative stress in healthy individuals and patients with type 2diabetes[J].Atherosclerosis,2001.154(2):475-483.
[10]Varughese GI,Tomson J,Lip GY.Type 2 diabetes mellitus:a cardiovascular perspective[J].Int J Clin Pract,2005,59(7):798-816.
[11]Evans JL,GoldfineID,Maddux BA,et al.Oxidative stress and stress-activated signaling pathways:a unifying hypothesis of type 2diabetes.EndocrRev,2002,23:599-622.
[12]黄敬泽,王健,张闽珍,等.血管内皮细胞损伤在2型糖尿病血管病变中的意义[J].中华内分泌代谢杂志,2000,16(3):169-171.
[13]Yu Y.Lyons TJ.A lethal tetrad in diabetes:hyperglycemia,dyslipidemia,oxidative stress,and endothelial dysfunction[J].Am J Med Sci,2005,330(5):227-232.
[14]M,Egberg N,Wamala S,Orth-Gomer K,Mittleman MA,Schenck-Gustafsson K.Relationship between plasma fibrinogen and coronary heart disease in women.Arterioscler Thromb Vasc Biol.1999 Jan;19(1):67-72.
[15]Fowkes FG;Lowe GD,Connor JM,Rumley A.Fibrinogen,factor Ⅶ and PAI-1 genotypes and the risk of coronary and peripheralatherosclerosis:Edinburgh Artery Study.Thromb Haemost. 1999 Apr;81(4):553-60.
[16]Sato S, Nakamura M, Iida M, Naito Y, Kitamura A, Okamura T, Nakagawa Y, Imano H, Kiyama M, Iso H, Shimamoto T, Komachi Y. Plasma fibnnogen and coronary heart disease in urban Japanese. Am J Epidemiol. 2000 Sep 1;152(5):420-3.
[17]Maroaca G, Blasio AD, Marchioli R, et al. Measuring plasma fibrinogento predict stroke and myocardial infarction an update. ArteriosclerThromb Vasc Biol. 1999 Jun; 19(6): 1368-77.
[18]Wong TY. Szeto CC. Chow KM, et al. Contribution of gene polymorphisms in the rennin-angiotensin system to macroangiopathy in patients with diabetic nephropathy[J]. Am J Kidney Dis, 2001; 38(1): 9-17.
[19]Jandeleit-Dahm K, Cooper ME. Hypertension and diabetes: role of the renin-angiotensin system [J]. Endocrinol Metab Clin North Am, 2006,35(3): 469-490.
[20]Haidari M , Javadl E, Sadeghi B, et al. Evaluation of C reactive protein, a sensitive marker of inflammation, as a risk factor for stable coronary artery disease[J]. Clin Biochemo 2001. 34(4):309—312
[21]Vincenzo P, James TW, Edward THY. Direct Proinflammatory Effect of C-Reactive Protein on Human Endothelia Cells[J]. Circulation, 2000, 102: 2165-2168.
[22]Sridevid D, Dan Y X, Ishwarlal J. C-Reactive Protein Increases Plasminogen Activator Inhibitor-1 Expression and Activity in Human Aortic Endothelial Cells:Implications for the Metabolic Syndrome and Atherothrombosis[J].Circulation,2003,107:398-404.
[23]Anderas F,Rash DA Jr,George GE,et al.Chronic Subclinical Infammafion as Part of the Insulin Resistance Syndrome..The Insulin Resistance Atherosclerosis Study(IRAS)[J].Circulation,2000,102:42-47.
[24]Paul M,Ridker MD.Nader R,et.Comparison of C-reactive protein and low-density lipopmtein cholesterol levels in the prediction of first cardiovacular events.N Eng J Med,2002,347(20):1557-1560.
[25]Bramlage P,Wittchen HU,Pittrow D.et al.Microalbuminuria is an early marker for increased morbidity and mortality[J].Fortschr Med Orlg,2003,121(Suppl 1):28-32.
[26]杨文英.陈晓平,杨兆军,等.不同BMI水平对血糖、血脂及血压的影响[J].中国糖尿病杂志.2001,9(5):275-278.