不同血糖水平的老年男性冠心病患者冠脉造影特点及相关因素分析
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摘要
目的探讨不同血糖水平的老年男性冠心病患者的临床及冠脉造影特点，分析其冠状动脉多支病变的危险因素。
方法根据血糖水平将114例老年男性冠心病患者分为三组，即血糖正常组（NGT，n=48）、糖调节受损组(IGR, n=23)、糖尿病组(DM, n=43)。对三组患者一般资料、血生化指标及冠状动脉造影结果进行比较，并进行统计学处理。
结果血清生化指标中,DM组和IGR组的FPG、PPG、HbA1c、UA、ALT、ALP、hs-CRP水平明显高于NGT组(P <0.05)，DM组的FPG、PPG、HbA1c、UA、hs-CRP水平进一步明显高于IGR组，差异有统计学意义(P <0.05)。三组患者的年龄、吸烟史、高血压病史、BMI水平差异无统计学意义(P>0.05)。在冠脉病变方面，DM组与IGR组多支冠脉病变的发生率明显高于NGT组（83.7%、65.2%、41.6%），单支病变率低于NGT组(P <0.05)。DM组冠状动脉弥漫性病变患病率（51.2%）显著高于IGR组（21.7%）和NGT组（12.5%），差异有统计学意义(P=0.015，P=0.001)，冠状动脉重度狭窄、完全闭塞性病变患病率在IGR组(87.0%,26.1%)和DM组(95.3%,51.2%)明显高于NGT组(52.1%,6.3%)(P <0.05)。Logistic回归分析提示FPG、PPG、HbA1c、UA、ALT、ALP、hs-CRP是老年男性冠心病患者多支病变发生的危险因素。
结论老年男性冠心病患者合并糖尿病或糖耐量异常时，其冠状动脉病变更严重，多支病变、弥漫性病变明显高于血糖正常者。FPG、PPG、HbA1c、UA、ALT、ALP、hs-CRP是老年男性冠心病患者多支病变发生的危险因素。
Objective To eluciate the influence of blood glucose on the coronary artery disease(CAD) in elder male patients through comparing the clinical features and the angiographiccharacteristics with different blood glucose levels.
Methods One hundred and fourteen elder male patients with CAD were dividedinto three groups based on their glucose levels：normal glucose tolerance group (NGT，n=48), impaired glucose regulation group (IGR, n=23) and diabetic group (DM, n=43).The angiography of coronary artery were performed, and the biochemical parameters andclinical characteristics among three groups were compared. The associated factors of CADwere determined with logistic regression analysis.
Results The levels of FPG,PPG,HbA1c,UA,ALT,ALP and hs-CRP in DM groupand IGR group were significantly higher than those in NGT group(P <0.05),while thelevels of FPG,PPG,HbA1c,UA, hs-CRP in IGR group were siganificantly lower than thosein DM group(P <0.05).But there were no statistically significant differences in theproportions of aging, smoking history, hypertension history and BMI among threegroups(P>0.05). The prevalence of multiple vessel lesion in diabetic group(83.7%) andIGR group(65.2%) was significantly higher than that in NGT group(41.6%). However,more single vessel lesions were found in NGT group(P <0.05). There was a significanthigher incidence of diffusive lesions in DM group(51.2%) as compared to that in IGRgroup(21.7%) and NGT group(12.5%)(P=0.015, P=0.001). Severe coronary arterialstenosis and complete occlusions occurred more in IGR group(87.0%,26.1%) and DMgroup(95.3%,51.2%) than those in NGT group(52.1%,6.3%). Logistic regression analysisrevealed that FPG, PPG, HbA1c, UA, ALT, ALP, hs-CRP were independent risk factors ofCAD with multiple vessel lesions in elder male patients.
Conclusions Coronory artery lesions are more severe in elderly male patients withDM and IGR. Moreover, the incidence of multiple vessel lesions and diffusive lesions are higher in DM and IGR group than that in NGT group. FPG, PPG, HbA1c, UA, ALT, ALP,hs-CRP are independent risk factors of CAD with multiple vessel lesions in elder males.
方法根据血糖水平将114例老年男性冠心病患者分为三组，即血糖正常组（NGT，n=48）、糖调节受损组(IGR, n=23)、糖尿病组(DM, n=43)。对三组患者一般资料、血生化指标及冠状动脉造影结果进行比较，并进行统计学处理。
结果血清生化指标中,DM组和IGR组的FPG、PPG、HbA1c、UA、ALT、ALP、hs-CRP水平明显高于NGT组(P <0.05)，DM组的FPG、PPG、HbA1c、UA、hs-CRP水平进一步明显高于IGR组，差异有统计学意义(P <0.05)。三组患者的年龄、吸烟史、高血压病史、BMI水平差异无统计学意义(P>0.05)。在冠脉病变方面，DM组与IGR组多支冠脉病变的发生率明显高于NGT组（83.7%、65.2%、41.6%），单支病变率低于NGT组(P <0.05)。DM组冠状动脉弥漫性病变患病率（51.2%）显著高于IGR组（21.7%）和NGT组（12.5%），差异有统计学意义(P=0.015，P=0.001)，冠状动脉重度狭窄、完全闭塞性病变患病率在IGR组(87.0%,26.1%)和DM组(95.3%,51.2%)明显高于NGT组(52.1%,6.3%)(P <0.05)。Logistic回归分析提示FPG、PPG、HbA1c、UA、ALT、ALP、hs-CRP是老年男性冠心病患者多支病变发生的危险因素。
结论老年男性冠心病患者合并糖尿病或糖耐量异常时，其冠状动脉病变更严重，多支病变、弥漫性病变明显高于血糖正常者。FPG、PPG、HbA1c、UA、ALT、ALP、hs-CRP是老年男性冠心病患者多支病变发生的危险因素。
Objective To eluciate the influence of blood glucose on the coronary artery disease(CAD) in elder male patients through comparing the clinical features and the angiographiccharacteristics with different blood glucose levels.
Methods One hundred and fourteen elder male patients with CAD were dividedinto three groups based on their glucose levels：normal glucose tolerance group (NGT，n=48), impaired glucose regulation group (IGR, n=23) and diabetic group (DM, n=43).The angiography of coronary artery were performed, and the biochemical parameters andclinical characteristics among three groups were compared. The associated factors of CADwere determined with logistic regression analysis.
Results The levels of FPG,PPG,HbA1c,UA,ALT,ALP and hs-CRP in DM groupand IGR group were significantly higher than those in NGT group(P <0.05),while thelevels of FPG,PPG,HbA1c,UA, hs-CRP in IGR group were siganificantly lower than thosein DM group(P <0.05).But there were no statistically significant differences in theproportions of aging, smoking history, hypertension history and BMI among threegroups(P>0.05). The prevalence of multiple vessel lesion in diabetic group(83.7%) andIGR group(65.2%) was significantly higher than that in NGT group(41.6%). However,more single vessel lesions were found in NGT group(P <0.05). There was a significanthigher incidence of diffusive lesions in DM group(51.2%) as compared to that in IGRgroup(21.7%) and NGT group(12.5%)(P=0.015, P=0.001). Severe coronary arterialstenosis and complete occlusions occurred more in IGR group(87.0%,26.1%) and DMgroup(95.3%,51.2%) than those in NGT group(52.1%,6.3%). Logistic regression analysisrevealed that FPG, PPG, HbA1c, UA, ALT, ALP, hs-CRP were independent risk factors ofCAD with multiple vessel lesions in elder male patients.
Conclusions Coronory artery lesions are more severe in elderly male patients withDM and IGR. Moreover, the incidence of multiple vessel lesions and diffusive lesions are higher in DM and IGR group than that in NGT group. FPG, PPG, HbA1c, UA, ALT, ALP,hs-CRP are independent risk factors of CAD with multiple vessel lesions in elder males.
引文
[1] Yang W, Lu J, Weng J,et al. Prevalence of diabetes among men and women in China.N Engl J Med,2010,362:1090-1101.
[2]《临床内分泌学》，陈家伦主编，2011年8月第一版,935-936.
[3] Haffner S，Lehto S，Ronnemaa T,et a1．Mortality from coronary heart disease insubjects with type2diabetes and in nondiabetic subjects with and without priormyocardial infarction．N Engl J Med,1998,339：229-234．
[4]苏海燕,潘长玉,刘敏,等.从冠脉造影病变程度及心血管危险因素角度探讨空腹血糖受损界值下调的临床意义.中华内分泌代谢杂志，2008,24:261-264.
[5] Haffner M，Ferrannini E，Hazuda HP，et al．Clustering of cardiovascular risk factorsin confirmed prehypertensive individuals．Hypertension，1992，20：38．
[6] Soinio M，Lehto S，Marniemi J，et a1．High-sensitivity C-reactive protein and coronaryheart disease mortality in patients with type2diabetes．Diabetes Care，2006，29：329-333．
[7] Jones RD, Nettleship JE, KapoorD, et al. Testosterone and atherosclerosis in aging men.Am J Cardiovasc Drugs,2005,5(3):141-154.
[8] Hak AE, Witteman JC, De Jong FH, et al. Low levels of endogenous androgen increasethe risk of atherosclerosis in elderly men: The Rotterdam Study. The Journal ofClinical Endocrinology&Metabolism,2002,87(8):3632～3639.
[9]曹国良，乔永芳.2型糖尿病餐后高血糖与心血管危险.医学与哲学，2004,11:44.
[10] Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis:glycosylated hemoglobinand cardiovascular disease in diabetes mellitus [J]. Ann Intern Med,2004,141(6):421-431.
[11] Ravipati G, Aronow WS, Ahn C, et al. Association of hemoglobin A(1c)level with theseverity of coronary artery disease in patients with diabetes mellitus[J].Am JCardiol,2006,97(7):968-969.
[12] Falcone C，Nespoli L，Geroldi D，et a1．Diluent myocardial ischemia in diabetic andnondiabetic patients with coronary artery disease．Int J Cardiol，2003，90：219-227．
[13]刘帆,黄新平,杨红玲,等.冠心病合并糖代谢异常患者冠状动脉病变特点的研究.中国实用医药,2010,27:75-76.
[14] Zornitzki T,Ayzenberg O,Gandelman G，et a1．Diabetes，but not the metabolicsyndrome，predicts the severity and extent of coronary artery disease in womenQJM,2007,100：575-81．
[15]王华,冯波,王元元.冠心病伴2型糖尿病患者临床和冠脉造影分析.同济大学学报（医学版）2010,31（1）：79-83.
[16] Alderman M, Aiyer KJ. Uric acid：role in cardiovascular disease and effects oflosartan [J]. Curr Med Res Opin，2004，20(3)：369-379.
[17]江雨萍，李青，马超.380例2型糖尿病患者血尿酸水平检测结果分析[J].当代医学杂志，2011,7（10）：41-42.
[18]刘颖颖,王林,马金萍等.血尿酸水平与冠心病及其严重程度的关系研究[J].天津医药,2012,40(4):320-322.
[19]冯烨，李成江.肝酶与糖代谢紊乱相关性研究.2008年浙江省内分泌学学术会议.
[20]陈晓平，杨文英，萧建中，等．马来酸罗格列酮干预高脂饲养大鼠脂肪肝的研究[J]．中国糖尿病杂志，2006，14(5)：380-382．
[21] Caldwell SH，Argo CK，AI-Osaimi AM．Therapy of NAFLD：insulin sensitizingagents [J]．J Clin Gastroenterol，2006，40(Supp．1)：S61-S66．
[22] Schindhelm RK, Dekker JM, Nijpels G, et a1．Alsnine aminotransferase predictscoronary heart disease events a10-year follow-up of the Hoom Study[J]．Atherosclerosis,2007．191(2)：391-396．
[23] Ikejima K，Okamura K，Lang T，et al. The role of leptin in progreasion ofnon-alcoholic fatty liver disease [J]. Hepatol Res,2005,33(2):151-154.
[24] Pagano C，Soardo G，Pilon C，et al.Increased serum resistin in nonalcoholic fatty liverdisease is related to liver disease severity and not to insulin resistance[J]. J clinEndocrinol Metab，2006，91(3):1081-1086.
[25] Ford ES．The metabolic syndrome and C—reative protein，fibfinogen，and leukocytecount：findings from the Third National Health and Nutriton Examination Survey.Atherosclerosis,2003,168：351-358．
[26]王先令，陆菊明，潘长玉．不同糖耐量水平者血清C反应蛋白水平及阿卡波糖干预的影响．中华内分泌代谢杂志，2003，19(4)：254
[27] Reynolds GD,Vance RP. C-reactive protein immunohistochemical localization innormal and atherosclerotie human aortas[J]. Arch Pathol Lab Med,1987,111:265-269.
[28] Pasceri V，Willerson J，Yeh E. Direct proinflammatory effect of C-rective protein onhuman endothelial cells. Circulation,2000,102：2165-2168．
[29] Zwaka T，Hombach V, Torzewski J．C-reactive protein-mediated low densitylipoprotein uptake by macrophages:implications for atherosclerosis．Circulation，2001，103:1194-1197．
[30] Devaraj S, Yan Xu D, Jialal I．C-reactive protein increases plasminogen activatorinhibitor-1expression and activity in human aortic endothelial cells：implications forthe metabolic syndrome and atherothrombosis．Circulation,2003，l07：398—404．
[1] Waddington C. Elevated uric acid can raise risk for CHD[J].CardinalToday,1999,34(2):15.
[2] Moriarity JT, Folsom AR, Iribarren C, et al. Serum acid uric and risk of coronary heartdisease:Atherosclerosis Risk in Communities(ARIC) study [J]. Ann Epidemiol,2000,10(3):136-143.
[3]方圻,游凯,林其燧,等.中国正常人血尿酸调查及其与血脂的关系[J].中华内科杂志,1983,22(7):434-438.
[4]方卫纲,黄晓明,王玉,等.高尿酸血症在北京地区1997人中的患病情况及相关因素分析[J].中华医学杂志,2006,26(25):1764.
[5]胡大一,丁荣晶.无症状高尿酸血症合并心血管疾病诊治建议中国专家共识(2009).
[6]江雨萍,李青,马超.380例2型糖尿病患者血尿酸水平检测结果分析[J].当代医学杂志,2011,7(10):41-42.
[7]朱敏,俞茂华,史虹莉,等.初发糖尿病合并高尿酸血症的相关因素分析[J].复旦学报(医学版),2004,31:71-73.
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[10]周守勤,牛秀丽.2型糖尿病患者血清尿酸水平与血糖、血脂的关系[J].现代中西医结合杂志,2007,16（19）：2677-2678.
[11]王秀问,程梅,张宝珠,等.中老年2型糖尿病患者血糖尿酸水平与血糖血脂的关系[J].中国糖尿病杂志,1996,4(1):21-22
[12]王孝铭,王宪衍,钱文琪等.原发性高血压患者的高尿酸血症[J].中华内科杂志,1985,24(12):709.
[13]Sund strom J, Sullivan L, Agost ino RB, et al. Relations of serum uric acid to longitudin al blood pressure tracking and hypertension incidence[J]. Hypertension,2005,45(1):28-33.
[14]Okura T, Higaki J, Kurata M,et al. Elevated serum uric acid is anindependent predictor for cardiovascular events in patients with severecoronary artery stenosis: subanalysis of the Japanese Coronary artery Disease (JCAD)Study [J].Circ J,2009,73(5):885-891.
[15]殷卫兵,杨芳.血清尿酸与冠心病的关系研究［J］.检验医学,2007,22(2):200201.
[16]黄祥征,潘超英.冠心病患者血清尿酸和胆红素测定的临床意义［J］.广西医学,2013,35(1):79-80.
[17] Alderman M，Aiyer KJ. Uric acid：role in cardiovascular disease and effects oflosartan [J]. Curr Med Res Opin，2004，20(3)：369-379.
[18]心血管疾病防治指南与共识,人民卫生出版社ISBN978-7-117-12128-6/R.12129,p198-213.
[2]《临床内分泌学》，陈家伦主编，2011年8月第一版,935-936.
[3] Haffner S，Lehto S，Ronnemaa T,et a1．Mortality from coronary heart disease insubjects with type2diabetes and in nondiabetic subjects with and without priormyocardial infarction．N Engl J Med,1998,339：229-234．
[4]苏海燕,潘长玉,刘敏,等.从冠脉造影病变程度及心血管危险因素角度探讨空腹血糖受损界值下调的临床意义.中华内分泌代谢杂志，2008,24:261-264.
[5] Haffner M，Ferrannini E，Hazuda HP，et al．Clustering of cardiovascular risk factorsin confirmed prehypertensive individuals．Hypertension，1992，20：38．
[6] Soinio M，Lehto S，Marniemi J，et a1．High-sensitivity C-reactive protein and coronaryheart disease mortality in patients with type2diabetes．Diabetes Care，2006，29：329-333．
[7] Jones RD, Nettleship JE, KapoorD, et al. Testosterone and atherosclerosis in aging men.Am J Cardiovasc Drugs,2005,5(3):141-154.
[8] Hak AE, Witteman JC, De Jong FH, et al. Low levels of endogenous androgen increasethe risk of atherosclerosis in elderly men: The Rotterdam Study. The Journal ofClinical Endocrinology&Metabolism,2002,87(8):3632～3639.
[9]曹国良，乔永芳.2型糖尿病餐后高血糖与心血管危险.医学与哲学，2004,11:44.
[10] Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis:glycosylated hemoglobinand cardiovascular disease in diabetes mellitus [J]. Ann Intern Med,2004,141(6):421-431.
[11] Ravipati G, Aronow WS, Ahn C, et al. Association of hemoglobin A(1c)level with theseverity of coronary artery disease in patients with diabetes mellitus[J].Am JCardiol,2006,97(7):968-969.
[12] Falcone C，Nespoli L，Geroldi D，et a1．Diluent myocardial ischemia in diabetic andnondiabetic patients with coronary artery disease．Int J Cardiol，2003，90：219-227．
[13]刘帆,黄新平,杨红玲,等.冠心病合并糖代谢异常患者冠状动脉病变特点的研究.中国实用医药,2010,27:75-76.
[14] Zornitzki T,Ayzenberg O,Gandelman G，et a1．Diabetes，but not the metabolicsyndrome，predicts the severity and extent of coronary artery disease in womenQJM,2007,100：575-81．
[15]王华,冯波,王元元.冠心病伴2型糖尿病患者临床和冠脉造影分析.同济大学学报（医学版）2010,31（1）：79-83.
[16] Alderman M, Aiyer KJ. Uric acid：role in cardiovascular disease and effects oflosartan [J]. Curr Med Res Opin，2004，20(3)：369-379.
[17]江雨萍，李青，马超.380例2型糖尿病患者血尿酸水平检测结果分析[J].当代医学杂志，2011,7（10）：41-42.
[18]刘颖颖,王林,马金萍等.血尿酸水平与冠心病及其严重程度的关系研究[J].天津医药,2012,40(4):320-322.
[19]冯烨，李成江.肝酶与糖代谢紊乱相关性研究.2008年浙江省内分泌学学术会议.
[20]陈晓平，杨文英，萧建中，等．马来酸罗格列酮干预高脂饲养大鼠脂肪肝的研究[J]．中国糖尿病杂志，2006，14(5)：380-382．
[21] Caldwell SH，Argo CK，AI-Osaimi AM．Therapy of NAFLD：insulin sensitizingagents [J]．J Clin Gastroenterol，2006，40(Supp．1)：S61-S66．
[22] Schindhelm RK, Dekker JM, Nijpels G, et a1．Alsnine aminotransferase predictscoronary heart disease events a10-year follow-up of the Hoom Study[J]．Atherosclerosis,2007．191(2)：391-396．
[23] Ikejima K，Okamura K，Lang T，et al. The role of leptin in progreasion ofnon-alcoholic fatty liver disease [J]. Hepatol Res,2005,33(2):151-154.
[24] Pagano C，Soardo G，Pilon C，et al.Increased serum resistin in nonalcoholic fatty liverdisease is related to liver disease severity and not to insulin resistance[J]. J clinEndocrinol Metab，2006，91(3):1081-1086.
[25] Ford ES．The metabolic syndrome and C—reative protein，fibfinogen，and leukocytecount：findings from the Third National Health and Nutriton Examination Survey.Atherosclerosis,2003,168：351-358．
[26]王先令，陆菊明，潘长玉．不同糖耐量水平者血清C反应蛋白水平及阿卡波糖干预的影响．中华内分泌代谢杂志，2003，19(4)：254
[27] Reynolds GD,Vance RP. C-reactive protein immunohistochemical localization innormal and atherosclerotie human aortas[J]. Arch Pathol Lab Med,1987,111:265-269.
[28] Pasceri V，Willerson J，Yeh E. Direct proinflammatory effect of C-rective protein onhuman endothelial cells. Circulation,2000,102：2165-2168．
[29] Zwaka T，Hombach V, Torzewski J．C-reactive protein-mediated low densitylipoprotein uptake by macrophages:implications for atherosclerosis．Circulation，2001，103:1194-1197．
[30] Devaraj S, Yan Xu D, Jialal I．C-reactive protein increases plasminogen activatorinhibitor-1expression and activity in human aortic endothelial cells：implications forthe metabolic syndrome and atherothrombosis．Circulation,2003，l07：398—404．
[1] Waddington C. Elevated uric acid can raise risk for CHD[J].CardinalToday,1999,34(2):15.
[2] Moriarity JT, Folsom AR, Iribarren C, et al. Serum acid uric and risk of coronary heartdisease:Atherosclerosis Risk in Communities(ARIC) study [J]. Ann Epidemiol,2000,10(3):136-143.
[3]方圻,游凯,林其燧,等.中国正常人血尿酸调查及其与血脂的关系[J].中华内科杂志,1983,22(7):434-438.
[4]方卫纲,黄晓明,王玉,等.高尿酸血症在北京地区1997人中的患病情况及相关因素分析[J].中华医学杂志,2006,26(25):1764.
[5]胡大一,丁荣晶.无症状高尿酸血症合并心血管疾病诊治建议中国专家共识(2009).
[6]江雨萍,李青,马超.380例2型糖尿病患者血尿酸水平检测结果分析[J].当代医学杂志,2011,7(10):41-42.
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