郑凌飞,韩雅玲,荆全民,王效增,李毅,张磊,霍勇,张岩

• 1:沈阳军区总医院心内科
• 2:北京大学第一医院心内科

摘要(Abstract)：

目的探讨冠状动脉病变程度与2型糖尿病(type 2 diabetes mellitus,T2DM)的相关性。方法收集9289例行诊断性冠状动脉造影疑诊冠状动脉疾病(coronary artery disease,CAD)的患者进行回顾性分析,以冠状动脉造影阳性(主要血管直径狭窄≥50%)作为诊断CAD的标准,确诊CAD者6119例(65.9%),未确诊CAD患者3170例(34.1%),其中合并T2DM的2150例(23.1%)患者作为观察组,未合并T2DM的7139例(76.9%)患者作为对照组。采用Gensini积分评价冠状动脉造影病变程度,并计数冠状动脉病变的支数。采用单因素方差分析及多因素回归分析评价糖尿病与冠状动脉狭窄程度间的关系。结果 2150例合并T2DM患者中确诊CAD患者1717例,占79.9%;7139例未合并T2DM患者中确诊CAD的患者4402例,占61.7%。糖尿病患者CAD患病率显著高于非糖尿病组(79.9%比61.7%,χ2=4.027,P<0.001),且冠状动脉病变程度更为严重,表现为患者平均病变支数更多(1.63±1.11比1.11±1.10,t=19.20,P<0.001)、Gensini积分更高(35.47±36.80比22.65±31.42,t=15.92,P<0.001);多因素Logistic回归分析显示糖尿病是CAD发生的的最强独立危险因素(OR值2.127,95%CI1.869～2.419,P<0.001)。结论糖尿病患者的CAD发病率明显高于非糖尿病组;糖尿病组患者冠状动脉狭窄程度更为严重;糖尿病与CAD发生的具有明显正相关性。

关键词(KeyWords)： 糖尿病,2型;冠状动脉疾病;冠状血管造影术

Abstract:

Keywords:

基金项目(Foundation): 十一五国家科技支撑计划(2006BAI01A02)

作者(Author): 郑凌飞,韩雅玲,荆全民,王效增,李毅,张磊,霍勇,张岩

参考文献(References)：

• [1]Stamler J,Vaccaro O,Neaton JD,et al.Diabetes,other risk factors,and12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial.Diabetes Care,1993,16:434-444.
• [2]Kannel WB,McGee DL.Diabetes and cardiovascular risk factors:the Framingham Study.Circulation,1979,59:8-13.
• [3]Vilbergsson S,Sigurdsson G,Sigvaldason H,et al.Coronaryheart disease mortality amongst non-insulin-dependent diabetic subjects in Iceland:the independent effect of diabetes.The Reykjavik Study17-year follow up.J Intern Med,1998,244:309-316.
• [4]Genuth S,Alberti KG,Bennett P,et al.Follow-up report on the diagnosis of diabetes mellitus.Diabetes Care,2003,26:3160-3167.
• [5]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease.Am J Cardiol,1983,51:606.
• [6]中华心血管杂志编辑委员会.血脂异常防治对策专题组.血脂异常防治建议.中华心血管病杂志,1997,25:169-170.
• [7]Chobanian AV,Bakris GL,Black HR,et al.Seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure.Hypertension,2003,42:1206-1252.
• [8]Ma YC,Zou L,Chen JH,et al.Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease.J Am Soc Nephrol,2006,17:2937-2944.
• [9]Folsom AR,Szklo M,Stevens J,et al.A prospective study of coronary heart disease in relation to fasting insulin,glucose,and diabetes.The Atherosclerosis Risk in Communities(ARIC)Study.Diabetes Care,1997,20:935-942.
• [10]Raza JA.Movahed A.Current concepts of cardiovascular disease in diabetes mellitus.Int J Cardiol,2003,89:123-134.
• [11]Gu K,Cowie CC,Harris MI.Diabetes and decline in heart disease mortality in US adults.JAMA,1999,281:1291-1297.
• [12]Alberti KG,Zimmet P,Shaw J.Metabolic syndrome-a new world-wide definition.A Consensus Statement from the International Diabetes Federation.Diabet Med,2006,23:469-480.
• [13]鄢高亮,韩雅玲,霍勇,等.2型糖尿病与绝经后女性冠心病患者冠状动脉狭窄程度的相关性分析.解放军医学杂志,2011,36:336-339.
• [14]Falcone C,Nespoli L,Geroldi D,et al.Dilent myocardial ischemia in diabetic and nondiabetic patients with coronary artery disease.Int J Cardiol,2003,90:219-227.
• [15]Balkau B,Shipley M,Jarrett RJ,et al.High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men20-year follow-up in the Whitehall Study,the Paris Prospective study,and the Helsinki Policemen study.Diabetes Care,1998,21:360-367.
• [16]Grant PJ.Diabetes and acute coronary syndromes-a diabetologist's view.Diab Vasc Dis Res,2005,2:103-104.
• [17]Grundy SM,Benjamin IJ,Burke GL,et al.Diabetes and cardiovascular disease:a statement for healthcare professionals from the American Heart Association.Circulation,1999,100:1134-1146.
• [18]Gaede P,Vedel P,Larsen N,et al.Multifactorial intervention and cardiovascular disease in patients with type2diabetes.N Engl J Med,2003,348:383-393.