2019 年第 11 期 第 14 卷

空腹血糖与糖化血红蛋白轻度升高的择期经皮冠状动脉介入治疗患者代谢综合征患病风险和复杂冠状动脉病变的相关性研究

Correlation among fasting blood glucose, metabolic syndrome and complex coronary artery disease in elective percutaneous coronary intervention patients with mildly elevated glycosylated hemoglobin

作者：杨杰周玉杰赵子威张婷玉程子超

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科

英文单位：

关键词：经皮冠状动脉介入；代谢综合征；糖尿病前期；糖化血红蛋白；空腹血糖

英文关键词：

• 摘要：

• 【摘要】目的    探讨在糖化血红蛋白（HbA1c）轻度升高的择期经皮冠状动脉介入（PCI）治疗患者中，空腹血糖与代谢综合征（MS）患病风险及复杂冠状动脉病变的相关性。方法    回顾性分析2017年8—12月首都医科大学附属北京安贞医院择期行PCI治疗的糖尿病前期患者（HbA1c 5.7%～6.4%）969例，根据空腹血糖分为空腹血糖受损（IFG）组（6.1 mmol/L≤空腹血糖＜7.0 mmol/L, 145例）和空腹血糖正常（NFG）组（空腹血糖＜6.1 mmol/L, 824例）。比较2组患者MS各组分特点、MS患病率及冠状动脉病变特点，同时分析是否合并MS对冠状动脉病变严重程度的影响，并进行Logistic回归分析探讨MS的独立影响因素。结果    IFG组超重和/或肥胖、高血糖、血脂异常比例明显高于NFG组，差异均有统计学意义（均 P＜0.05）；IFG组MS患病率明显高于NFG组［65.5%（95/145）比20.4%（168/824）］，差异有统计学意义（P＜0.001）。IFG组3支病变比例及Gensini积分明显高于NFG组［33.8%(49/145)比25.1%(207/824)、（39±33）分比（31±29）分］，差异均有统计学意义（均P＜0.05）。与非MS组相比，MS组有更高的3支病变比例以及更高的Gensini积分［37.3%(98/263)比22.4%(158/706)、（43±28）分比（27±26）分］，差异均有统计学意义（均P＜0.01）。Logistic回归分析显示空腹血糖和HbA1c均与MS独立相关（比值比＝5.65、3.76，均P＜0.001）。结论    与单纯HbA1c升高的择期PCI的糖尿病前期患者相比，HbA1c与空腹血糖均升高的患者MS的患病风险更高，冠状动脉病变更复杂。联合HbA1c及空腹血糖可以更好地评估择期PCI患者MS的患病风险及冠状动脉病变严重程度。

• 【Abstract】Objective    To explore the correlation among fasting blood glucose(FBG), metabolic syndrome(MS) and complex coronary artery disease in patients with elevated glycosylated hemoglobin(HbA1c) undergoing percutaneous coronary intervention(PCI). Methods    Clinical data of 969 prediabetic patients（HbA1c 5.7%-6.4%）undergoing elective PCI from August to December 2017 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. The patients were divided into impaired fasting glucose(IFG) group(6.1 mmol/L≤FBG＜7.0 mmol/L, 145 cases) and normal fasting glucose(NFG) group(FBG<6.1 mmol/L, 824 cases). Prevalence and characteristics of MS and severity of coronary artery lesions were analyzed. Independent risk factors of MS were analyzed by logistic regression. Results    IFG group had more overweight patients, more hyperglycemia and dyslipidemia（all P＜0.05）. Morbidity rate of MS in IFG group was significantly higher than that in NFG group［65.5%（95/145） vs 20.4%（168/824）］（P＜0.001）. Proportion of coronary three-vessel disease and Gensini score in IFG group were significantly higher than those in NFG group［33.8%(49/145) vs 25.1%(207/824), （39±33） vs （31±29）］（both P＜0.05）. Compared with non-MS patients, MS patients had higher proportion of three-vessel disease and higher Gensini score［37.3%(98/263) vs 22.4%(158/706), （43±28） vs （27±26）］（both P＜0.01）. Logistic regression analysis showed that FBG and HbA1c were independently associated with MS(odds ratio=5.65, 3.76; both P＜0.001). Conclusions    Prediabetic patients with elevated HbA1c and FBG have higher risk of MS and more complicated coronary lesions. HbA1c combined with FBG can evaluate the risk of MS and the severity of coronary artery disease in patients undergoing elective PCI.