【摘要】：目的探討糖調(diào)節(jié)受損對(duì)冠心病患者早期診斷及預(yù)后的價(jià)值。方法選擇我院2011年心內(nèi)科明確診斷為冠心病并進(jìn)行選擇性冠脈造影檢查的住院患者521例作為CHD組,經(jīng)有關(guān)檢查排除CHD的門診患者200例作為對(duì)照組,除已確診糖尿病的121例CHD患者外,其余研究對(duì)象均測(cè)定空腹血糖(FBG)及OGTT 2h血糖(2h-PG),同時(shí)測(cè)定血脂水平并記錄相關(guān)病史。比較IGR在冠心病組與對(duì)照組的發(fā)生情況,并對(duì)導(dǎo)致IGR的危險(xiǎn)因素進(jìn)行多元Logistic回歸分析;根據(jù)FBG及2h-PG結(jié)果將CHD組分為三個(gè)亞組:血糖正常組(NGT組)138例、糖調(diào)節(jié)受損組(IGR組)168例,糖尿病組(DM組)215例,比較三組患者冠脈病變特點(diǎn)的異同。對(duì)所有研究對(duì)象進(jìn)行隨訪,平均隨訪時(shí)間3.5年,觀察患者M(jìn)ACCE事件(非致死性卒中、非致死性心肌梗死、心衰、再介入、全因死亡)的發(fā)生情況。結(jié)果(1)CHD組患者中糖代謝異常的發(fā)生率為73.5%,其中IGR為32.2%、DM為41.3%,IGR的發(fā)生率明顯高于對(duì)照組(21.5%),差異具有顯著性(x2=0.062,P=0.005);(2)521例CHD患者中262例均為入院后新發(fā)現(xiàn)的糖代謝異常患者,其中168例IGR患者中空腹血糖受損(IFG)為54例、糖耐量異常(IGT)114例,新發(fā)現(xiàn)的94例DM患者中空腹高血糖(IFH)11例、餐后高血糖(IPH)83例。(3)DM組與IGR組患者的年齡、BMI、血脂水平及合并有高血壓病、早發(fā)缺血性心血管病家族史的人數(shù)顯著高于血糖正常組(P0.01),而DM組與IGR組水平相當(dāng)(P0.05);(4)多因素回歸分析表明,年齡、高血壓病史、甘油三酯、膽固醇、高密度脂蛋白膽固醇水平均是IGR的危險(xiǎn)因素;(5)餐后2h血糖、甘油三酯水平、年齡、BMI及吸煙史、早發(fā)缺血性心血管病家族史均是CHD的危險(xiǎn)因素,且餐后2h血糖是CHD的獨(dú)立危險(xiǎn)因素;(6)DM組與IGR組冠心病患者冠脈單支病變發(fā)生率低于血糖正常組,而雙支、三支病變發(fā)生率明顯高于血糖正常組,均具有顯著性差異(P0.05),而DM組與IGR組比較,無(wú)顯著性差異(P0.05);(7)平均3.5年的隨訪中,DM組與IGR組MACCE事件發(fā)生率顯著高于血糖正常組,差異具有顯著性(P0.05),而DM組與IGR組比較,無(wú)顯著性差異(P0.05);(8)除外215例DM患者,將其余研究對(duì)象分為IGR(+)組及IGR(-)組,在平均3.5年的隨訪中,IGR(+)組患者的MACCE事件發(fā)生率顯著高于IGR(-)組(P0.01)。結(jié)論冠心病患者多伴發(fā)糖調(diào)節(jié)受損,其發(fā)生糖尿病的風(fēng)險(xiǎn)增加,且對(duì)冠狀動(dòng)脈的損害與糖尿病相近,不僅會(huì)加重冠脈病變,同時(shí)與不良心血管事件的發(fā)生情況密切相關(guān),影響患者預(yù)后。早期發(fā)現(xiàn)糖代謝異常患者具有重要的臨床意義。
[Abstract]:Objective to investigate the value of impaired glucose regulation in early diagnosis and prognosis of coronary heart disease. Methods 521 inpatients who were diagnosed as coronary heart disease and underwent selective coronary angiography in our hospital in 2011 were selected as CHD group and 200 outpatients excluded from CHD as control group. Fasting blood glucose (FBG) and OGTT 2 h blood glucose (2h-PG) were measured in 121 patients with CHD. To compare the occurrence of IGR in CHD group and control group, and to analyze the risk factors of IGR by multivariate logistic regression analysis, according to the results of FBG and 2h-PG, the CHD group was divided into three subgroups: 138 cases in normal blood glucose group (NGT group) and 168 cases in impaired glucose regulation group (IGR group). Two hundred and fifteen patients with diabetes mellitus (DM) were compared with each other in the characteristics of coronary artery disease. All subjects were followed up for an average of 3.5 years to observe the occurrence of MACCE events (non-fatal stroke, non-fatal myocardial infarction, heart failure, re-intervention, all-cause death). Results (1) the incidence of abnormal glucose metabolism in CHD group was 73.5, and the incidence of IGR was 32.2% and 41.3% higher than that in control group (21.5%). The difference was significant (x2n0.062P0. 005); (2). Among 521 CHD patients, 262 were newly found abnormal glucose metabolism. Of 168 IGR patients, 54 were impaired fasting blood glucose (IFG), 114 were impaired glucose tolerance (IGT), 11 were fasting hyperglycemia (IFH) and 83 were postprandial hyperglycemia (IPH). The family history of premature ischemic cardiovascular disease was significantly higher than that of normal blood glucose group (P0.01), while the levels of DM and IGR4 were similar (P0.05); (4) multivariate regression analysis showed that age, history of hypertension, triglyceride, cholesterol, (5) 2h postprandial blood glucose, triglyceride level, age, BMI and smoking history, family history of early ischemic cardiovascular disease were all risk factors of CHD. 2 h postprandial blood glucose was an independent risk factor for CHD. (6) the incidence of coronary artery disease in DM and IGR groups was lower than that in normal glucose group, while the incidence of two-vessel and three-vessel lesion was significantly higher than that in normal glucose group. There was no significant difference (P0.05) between DM group and IGR group, but there was no significant difference (P0.05) between DM group and IGR group (P0.05). The incidence of MACCE in DM group and IGR group was significantly higher than that in normal blood glucose group (P0.05), but there was no significant difference between DM group and IGR group (P0.05), but there was no significant difference between DM group and IGR group in the incidence of MACCE in DM group and IGR group (P0.05). There was no significant difference (P0.05); (8) except 215 patients with DM. The other subjects were divided into IGR- group and IGR- group. The incidence of MACCE in IGR- group was significantly higher than that in IGR- group during an average follow-up of 3.5 years (P0.01). Conclusion the risk of diabetes is increased in patients with coronary heart disease with impaired glucose regulation, and the damage to coronary artery is similar to that of diabetes, which will not only aggravate coronary artery disease, but also be closely related to the occurrence of adverse cardiovascular events. Affect the prognosis of patients. Early detection of abnormal glucose metabolism has important clinical significance.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R587.2;R541.4

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王麗靜;卞志偉;;80例肥胖及糖調(diào)節(jié)受損人群的減重體會(huì)[J];中國(guó)實(shí)用醫(yī)藥;2009年24期

2 秦偉鋒;石巖;;糖調(diào)節(jié)受損臨床研究進(jìn)展[J];遼寧中醫(yī)藥大學(xué)學(xué)報(bào);2010年09期

3 陳瑛英;;糖調(diào)節(jié)受損人群的健康管理模式探討[J];中外婦兒健康;2011年07期

4 肖美芳;朱海萍;;葡萄糖調(diào)節(jié)受損的研究進(jìn)展[J];護(hù)理研究;2013年07期

5 侯進(jìn);張向紅;陸鳳華;;某社區(qū)糖調(diào)節(jié)受損患病調(diào)查的方法與質(zhì)量控制[J];上海醫(yī)藥;2014年08期

6 盧丹 ,韓立坤;糖調(diào)節(jié)受損人群亞組分布狀態(tài)及臨床特點(diǎn)[J];遼寧實(shí)用糖尿病雜志;2004年05期

7 楊瑞芬;糖調(diào)節(jié)受損的危害與干預(yù)[J];中西醫(yī)結(jié)合心腦血管病雜志;2004年12期

8 吳振麗,丁慧榮;華工社區(qū)人群糖調(diào)節(jié)受損干預(yù)治療[J];遼寧實(shí)用糖尿病雜志;2004年06期

9 吳振麗,丁慧榮;中北社區(qū)糖尿病及糖調(diào)節(jié)受損患者流行病學(xué)調(diào)查與研究[J];實(shí)用糖尿病雜志;2005年05期

10 潘杰;解亞寧;付利;;老年糖調(diào)節(jié)受損不同轉(zhuǎn)歸者主觀幸福感比較研究[J];護(hù)理學(xué)報(bào);2006年03期

相關(guān)會(huì)議論文 前10條

1 賈偉平;項(xiàng)坤三;陳蕾;陸俊茜;包玉倩;楊明;吳元民;;上海地區(qū)中國(guó)人糖調(diào)節(jié)受損的類型分布及伴隨的代謝異常[A];中華醫(yī)學(xué)會(huì)第六次全國(guó)內(nèi)分泌學(xué)術(shù)會(huì)議論文匯編[C];2001年

2 趙向彤;金勝鑫;潘優(yōu)津;;糖調(diào)節(jié)受損者血清血管細(xì)胞黏附分子-1水平的變化[A];浙江省中西醫(yī)結(jié)合學(xué)會(huì)糖尿病專業(yè)委員會(huì)第一次學(xué)術(shù)會(huì)議材料匯編[C];2006年

3 張進(jìn)軍;樊闖;葉美英;鄧永安;楊海偉;張建軍;;老年葡萄糖調(diào)節(jié)受損患病率動(dòng)態(tài)調(diào)查研究[A];中華醫(yī)學(xué)會(huì)第八次全國(guó)老年醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2007年

4 秦偉鋒;石巖;張文順;劉亮;;糖調(diào)節(jié)受損臨床研究進(jìn)展[A];第十二屆全國(guó)中醫(yī)糖尿病大會(huì)論文匯編[C];2010年

5 孫婉婉;劉宇;王天歌;李勉;徐佰慧;黃飛;楊枝;張婕;任晨曦;田曉光;徐敏;徐瑜;畢宇芳;;糖調(diào)節(jié)受損人群糖化血紅蛋白與頸動(dòng)脈內(nèi)中膜厚度的相關(guān)性研究[A];中華醫(yī)學(xué)會(huì)第十一次全國(guó)內(nèi)分泌學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2012年

6 張翼飛;李小英;洪潔;詹維偉;顧衛(wèi)瓊;楊義生;徐敏;寧光;;糖調(diào)節(jié)受損人群中負(fù)荷后血糖升高是早期動(dòng)脈粥樣硬化的重要危險(xiǎn)因素[A];2006年中華醫(yī)學(xué)會(huì)糖尿病分會(huì)第十次全國(guó)糖尿病學(xué)術(shù)會(huì)議論文集[C];2006年

7 許萍;陸大江;;糖調(diào)節(jié)受損患者的運(yùn)動(dòng)干預(yù)研究[A];第八屆全國(guó)體育科學(xué)大會(huì)論文摘要匯編（二）[C];2007年

8 滕云;;110例葡萄糖調(diào)節(jié)受損患者調(diào)查分析[A];中華醫(yī)學(xué)會(huì)第十二次全國(guó)內(nèi)分泌學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2013年

9 張寅飛;黃韻;陳曉鷗;管婭婭;劉奎;蘇玉霞;畢宇芳;應(yīng)秀玲;;上海郊區(qū)糖調(diào)節(jié)受損和糖尿病患病率及其危險(xiǎn)因素分析[A];中華醫(yī)學(xué)會(huì)第十次全國(guó)內(nèi)分泌學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2011年

10 甄東戶;湯旭磊;傅松波;成建國(guó);劉麗娟;趙楠;劉慧慧;;蘭州市城區(qū)40歲以上人群糖尿病及糖調(diào)節(jié)受損患病率調(diào)查[A];2012年甘肅省“食品安全與健康生活”學(xué)術(shù)年會(huì)論文集粹[C];2012年

相關(guān)重要報(bào)紙文章 前2條

1 葉常生;何謂糖調(diào)節(jié)受損[N];醫(yī)藥養(yǎng)生保健報(bào);2007年

2 本報(bào)記者 王寧 采訪整理;改善糖調(diào)節(jié)受損 控制血糖和糖脂代謝 染料木素 大豆甙元干預(yù)有效果?[N];中國(guó)食品報(bào);2012年

相關(guān)博士學(xué)位論文 前1條

1 閆曉光;糖調(diào)節(jié)受損者的生活方式干預(yù)及血漿Visfatin與ADMA水平的關(guān)系研究[D];中國(guó)醫(yī)科大學(xué);2010年

相關(guān)碩士學(xué)位論文 前10條

1 潘杰;老年糖調(diào)節(jié)受損者的應(yīng)對(duì)方式與主觀幸福感的研究[D];第一軍醫(yī)大學(xué);2006年

2 劉雯涓;津力達(dá)顆粒干預(yù)氣陰兩虛型糖調(diào)節(jié)受損者的療效研究[D];福建中醫(yī)藥大學(xué);2015年

3 王雪;不同糖耐量人群成纖維細(xì)胞生長(zhǎng)因子21與胰島細(xì)胞功能及C反應(yīng)蛋白水平的相關(guān)性研究[D];河北醫(yī)科大學(xué);2015年

4 毛月芹;上海農(nóng)村社區(qū)中老年人群糖代謝異常流行病學(xué)調(diào)查及自我效能情況[D];蘇州大學(xué);2015年

5 程林華;吸煙對(duì)糖調(diào)節(jié)受損患者血漿同型半胱氨酸濃度的影響[D];南昌大學(xué)醫(yī)學(xué)院;2015年

6 劉颯莎;低碳水化合物膳食對(duì)糖調(diào)節(jié)受損女性干預(yù)效果研究[D];上海體育學(xué)院;2015年

7 李亞歡;黃連降糖片干預(yù)糖調(diào)節(jié)受損的臨床研究[D];河南中醫(yī)學(xué)院;2015年

8 趙婷;糖調(diào)節(jié)受損對(duì)冠心病患者早期診斷及預(yù)后的價(jià)值[D];寧夏醫(yī)科大學(xué);2016年

9 王麗娟;糖調(diào)節(jié)受損與冠脈病變嚴(yán)重程度的相關(guān)性研究[D];延安大學(xué);2014年

10 王玲;社區(qū)糖調(diào)節(jié)受損患者的遵醫(yī)行為及對(duì)代謝的影響研究[D];山西醫(yī)科大學(xué);2010年

，

本文編號(hào)：2123097