未诊断糖尿病的冠心病患者糖代谢状况分析_《中国循证医学杂志》

作者：

温主治 ¹ , 张岚 ² , 张亚梅 ¹ , 王景峰 ¹ ,  耿登峰 ¹

1. 广州市中山大学第二附属医院心内科（广州?510120）；2. 广东省荣誉军人康复医院（广州市?510260）;

关键词：

冠脉造影冠心病糖代谢异常糖尿病口服葡萄糖耐量试验

DOI：

10.7507/1672-2531.20100515

视频：

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目的 ?探讨未诊断糖尿病但经冠脉造影确诊的冠心病住院患者（CAD）的糖代谢状况。
方法 ?采用横断面研究设计，纳入2007年1月至2009年5月在中山大学附二院心血管内科住院的患者499例，根据冠脉造影结果分为冠心病组和非冠心病组，比较两组的糖代谢异常情况。
结果 ?两组随机血糖（RPG）和空腹血糖（FPG）差异无统计学意义（P值分别为0.249和0.444），但OGTT 2小时血糖（2hPG）在冠心病组明显升高，差异有统计学意义（P lt;0.001）；冠心病组糖代谢异常患病率达74.0%，其中新诊断糖尿病32.1%，糖耐量异常（IGT）39.0%，分别高于非冠心病组的61.6%、36.0%和20.7%，两组差异有统计学意义（P=0.006）。logistic回归分析提示，冠心病组患者存在糖耐量异常和新诊断糖尿病的风险分别是非冠心病组患者的1.6倍［OR=1.603，95%CI（1.023，2.512），P=0.04］和2.3倍［OR=2.292，95%CI（1.391，3.777），P=0.001］，在纠正高血压、血脂异常、BMI、hs-CRP等因素后，冠心病组患者存在新诊断糖尿病风险仍较非冠心病组患者明显升高［OR=1.852，95%CI（1.064，3.223），P=0.029］。
结论 ?未诊断糖尿病的冠心病住院患者普遍存在糖代谢异常，这些患者大部分需要通过OGTT检查才能及时准确地诊断。OGTT应该作为发现冠心病住院患者糖代谢异常的常规检查项目，如可能，全部心血管住院患者均应常规行OGTT检查。

引用本文： 温主治,张岚,张亚梅,王景峰,耿登峰. 未诊断糖尿病的冠心病患者糖代谢状况分析. 中国循证医学杂志, 2010, 10(8): 892-896. doi: 10.7507/1672-2531.20100515 复制

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1. Hu DY, Pan CY, Yu JM, for the China Heart Survey Group. The relationship between coronary artery disease and abnormal glucose regulation in China: the China Heart Survey. Eur Heart J, 2006, 27: 2573-2579.
2. Bartnik M, Ryden L, Ferrari R, et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: the Euro Heart Survey on diabetes and the heart. Eur Heart J, 2004, 25: 1880-1890.
3. Stern MP. Diabetes and cardiovascular disease. The "common soil" hypothesis. Diabetes, 1995, 44(4): 369-374.
4. Barr EL, Zimmet PZ, Welborn TA, et al. Risk of Cardiovascular and All-Cause Mortality in Individuals With Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation, 2007, 116: 151-157.
5. Norhammar A, Malmberg K, Diderholm E, et al. Diabetes mellitus: The major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization. J Am Coll Cardiol, 2004, 43: 585-591.
6. Tamita K, Katayama M, Takagi T, et al. Impact of Newly Diagnosed Abnormal Glucose Tolerance on Long-Term Prognosis in Patients With Acute Myocardial Infarction. Circ J, 2007, 71: 834-841.
7. DECODE Study Group, the European Diabetes Epidemiology Group. Glucose tolerance and cardiovascular mortality: Comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med, 2001, 161: 397-405.
8. Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care,1997, 20: 537-544.
9. Chiasson JL, Josse RG, Gomis R, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: The STOPNIDDM trial. JAMA, 2003, 290: 486-494.
10. Bartnik M, Ryde´n L, Malmberg KO, et al. on behalf of the Euro Heart Survey Investigators. Oral glucose tolerance test is needed for appropriate classification of glucose regulation in patients with coronary artery disease. Heart, 2007, 93: 72-77.

《中国循证医学杂志》

未诊断糖尿病的冠心病患者糖代谢状况分析

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《中国循证医学杂志》

未诊断糖尿病的冠心病患者糖代谢状况分析

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