杨秀秀,苏工

• 1:首都医科大学附属北京安贞医院心内科

摘要(Abstract)：

目的探讨血糖变异性对2型糖尿病合并急性冠状动脉综合征(ACS)患者非罪犯病变快速进展的影响。方法连续纳入2014年1月至2017年6月北京安贞医院于罪犯病变部位成功置入支架的2型糖尿病合并ACS患者260例,术后(12±2)个月复查冠状动脉造影,观察冠状动脉非罪犯病变的进展情况,并据此将所有患者分为快速进展组(68例)和缓慢进展组(192例)。快速进展被定义为:首次冠状动脉造影管腔直径狭窄≥50%的病变,第二次造影内径减少≥10%;首次造影管腔狭窄<50%的病变,第二次造影内径减少≥30%;首次造影冠状动脉正常,第二次造影为新发病变,较之前正常时内径减少≥30%;首次造影无论为任何程度的狭窄病变,第二次造影进展为完全闭塞病变。只要符合上述≥1条即定义为快速进展。采用动态血糖监测系统进行连续3 d的血糖监测反映血糖波动情况。结果快速进展组日内平均血糖波动幅度(MAGE)[(3.96±1.46)mmol/L比(3.25±1.27)mmol/L,P<0.001]、餐后血糖波动幅度[(4.23±1.80)mmol/L比(3.52±1.42)mmol/L,P<0.001]和超敏C反应蛋白(hs-CRP)[(6.34±6.01)mg/L比(3.78±3.98)mg/L,P<0.001]水平均明显高于缓慢进展组,差异均有统计学意义。快速进展组三支病变比例明显高于缓慢进展组(36.8%比18.2%,P<0.001),差异有统计学意义。多因素logistic回归分析显示,MAGE(P=0.008)、hs-CRP(P=0.009)和三支血管病变(P=0.034)是非罪犯病变快速进展的独立危险因素。结论 MAGE是2型糖尿病合并ACS患者非罪犯病变快速进展的独立危险因素,血糖变异性的风险应该得到广泛关注。

关键词(KeyWords)： 血糖变异性;2型糖尿病;急性冠状动脉综合征;非罪犯病变;快速进展

Abstract:

Keywords:

基金项目(Foundation): 北京市保健专项基金资助项目(京15-10)

作者(Author): 杨秀秀,苏工

参考文献(References)：

• [1]ParkMW, SeungKB, KimPJ, et al. Long-termpercutaneous coronary intervention rates and associated independent predictors for progression of nonintervened nonculprit coronary lesions. Am J Cardiol, 2009, 104(5):648-652.
• [2]陈文明,李东宝,陈晖,等.冠状动脉病变支架后非罪犯病变快速进展的预测因子.首都医科大学学报, 2013,34(1):90-94.
• [3]AMonnierL,ColetteC, OwensDR.Integratingglycaemic variability in the glycaemic disorders of type 2 diabetes:a move towards a unified glucose tetrad concept. Diabetes Metab Res Rev,2009,25(5):393-402.
• [4]PenckoferS, Quinn L, Byrn M,et al. Does glycemic variability impact mood and quality of life? Diabetes Technol Ther,2012,14(4):303-310.
• [5]DerrR1, GarrettE, StacyGA, etal. IsHbA(1c)affected by glycemic instability? Diabetes Care,2003,26(10):2728-2733.
• [6]陈汉阳,刘文娴,张丽洁. 2型糖尿病合并冠心病患者冠状动脉病变与糖化血红蛋白水平的关系.中国介入心脏病学杂志,2011,19(2):88-90.
• [7]Piconi L, Quagliaro L, DaRos R, et al. Intermittenthigh glucose enhances ICAM-1,VCAM-1, E-selectin and interleukin-6 expression in human umbilical endothelial cells in culture:the role ofpoly(ADP-ribose)polymerase. JThrombHaemost, 2004, 2(8):1453-1459.
• [8]Gorst C, Kwok CS,Aslam S,et al. Long-term glycemic variability and risk of adverse outcomes:a systematic review and meta-analysis.Diabetes Care,2015,38(12):2354-2369.
• [9]申虎威,李燕,邢莉,杨爱萍.血糖波动与糖尿病大血管病变的相关研究.中国病理生理杂志, 2010,26(7):1311-1315.
• [10]杨秀秀,苏工. 2型糖尿病患者血糖变异性与冠状动脉病变程度之间的关系.心肺血管病杂志, 2017,36(6):15-19.
• [11]KaskiJC, ChesterMR, ChenL, et al. Rapidangiographic progression of coronary artery disease in patients with angina pectoris. The role of complex stenosis morphology. Circulation,1995, 92(8):2058-2065.
• [12]Zouridakis EG, Schwartzman R, Garcia-Moll X, et al. Increased plasma endothelin levels in angina patients with rapid coronary artery disease progression. Eur Heart J, 2001, 22(17):1578-1584.
• [13]Zouridakis EG, Avanzas P, Arroyo-Espliguero R, et al. Markers of inflammation and rapid coronary artery disease progression in patients with stable angina pectoris. Circulation, 2004,110(13):1747-1753.
• [14]美国糖尿病协会.英国前瞻性糖尿病研究(UKPDS)的意义.中国糖尿病杂志,1999,7(3):185-188.
• [15]许樟荣,钱荣立.英国前瞻性糖尿病研究(UKPDS)简介.中国糖尿病杂志,1999,7(2):117-118.
• [16]黎瑶,童南伟. 2003年第18届国际糖尿病联盟(IDF)年会专题报道DCCT/EDIC研究和Steno-2研究简介.国外医学内分泌学分册,2004,24(3):207-208.
• [17]Mi SH,Su G,Li Z et al.. Comparison of glycemic variability and glycated hemoglobin as risk factors of coronary artery disease in patients with undiagnosed diabetes. Chin Med J(Engl),2012,125(1):38-43.
• [18]Hirsch IB. Glycemic variability:it’s not just about HbA1C anymore.DiabetesTechnolTher, 2005, 7(5):780-783.
• [19]Del Prato S. In search of normoglycaemia in diabetes:controlling postprandialglucose. Int J Obes Relat Metab Disord, 2002,26 Suppl3:S9-S17.
• [20]Wang JS,Yin HJ,Guo CY,et al.Influence of high blood glucose fluctuation on endothelial function of type 2 diabetes mellitus rats and effects of panax quinquefolius saponin of stem and leaf. Chin J Integra Medi, 2013,19(3):217-222.
• [21]ChangCM, HsiehCJ, HuangJC,etal. Acute and chronic fluctuations in blood glucose levels can increase oxidative stress in type 2 diabetes mellitus. Acta Diabetol,2012(1):S171-S177.
• [22]Quagliaro L, Piconi L, Assaloni R, et al. Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cells. The role of protein kinase C and NAD(P)H-oxidase activation. Diabetes, 2003,52(11):2795-2804.
• [23]Watada H, Azuma K, Kawamori R. Glucose fluctuation on the progression of diabetic macroangiopathy--new findings from monocyte adhesion to endothelial cells. Diabetes Res Clin Pract,2007, 77(S1):S58-S61.
• [24]PirolaL. The DCCT/EDIC study:epigeneticcluesafterthree decades. Diabetes, 2014,63(5):1460-1462.
• [25]BalkauB.TheDECODEstudy.Diabetesepidemiology:collaborative analysis of diagnostic criteria in Europe. Diabetes Metab, 2000,26(4):282-286.
• [26]Monnier L, Colette C, Owens DR. Glycemic variability:the third component of the dysglycemia in diabetes. Is it important? How to measure Diabetes Sci Technol, 2008,2(6):1094-1100.