【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�；颊�,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�；颊呔哂兄匾呐R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

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