| 摘要: |
| 目的:探讨2型糖尿病（T2DM）与70岁以上冠心病（CHD）患者的临床特点及冠状动脉病变程度的关系。方法:回顾性分析本院2006年4月至2008年7月经冠状动脉造影证实的155例70岁以上T2DM合并CHD者（DMCHD）患者的临床资料，作为病例组，以同期155例性别匹配的70岁以上不合并T2DM的CHD患者为对照组，对两组患者进行年龄、性别、血压、血脂、凝血、射血分数等临床指标和冠状动脉造影结果的分析比较。结果:DMCHD组合并高血压的发病率明显高于NDMCHD组(P<0.05)，其空腹血糖（FBG）、三酰甘油（TG）、低密度脂蛋白胆固醇(LDLC)、纤维蛋白原（FIB）水平明显高于对照组(P<0.01)，而高密度脂蛋白胆固醇（HDLC）低于NDMCHD组(P<0.05)；DMCHD组左室射血分数（EF）显著低于NDMCHD组(P<0.01)。155例DMCHD患者，有35例初诊的DM患者（22％），若不行口服葡萄糖耐量试验(OGTT)而仅依靠FBG，则有14例DM患者漏诊（40％）。DMCHD组以弥漫病变为主(P<0.01)，冠脉狭窄指数及闭塞的血管数显著高于NDM组（P<0.01)。结论:CHD患者DM漏诊率较高；DMCHD较之NDMCHD患者存在更多的CHD危险因素，冠状动脉病变的范围和狭窄程度更严重。 |
| 关键词: 冠状动脉疾病 2型糖尿病 冠状动脉造影 胰岛素抵抗 老年人 |
| DOI：10.3724/SP.J.1008.2009.0286 |
| 投稿时间：2008-10-29修订日期：2009-01-14 |
| 基金项目: |
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| Clinical and coronary angiographic analysis of elderly patients with type 2 diabetes mellitus combined with coronary heart disease |
| LIU Su-xuan, QIN Yong-wen*,YOU Xiao-hua |
| (Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai 200433,China) |
| Abstract: |
| Objective:To analyze the association of type 2 diabetes mellitus (DM) with the clinical and coronary angiographic features of coronary heart disease (CHD) in patients aged over 70 years old. Methods: A total of 310 elderly patients with coronary angiographconfirmed coronary diseases, who were treated in Changhai Hospital during Apr. 2006 to Jul. 2008, were retrospectively analyzed. The patients were further divided into 2 subgroups according to the presence of DM: DMCHD group (n=155) and nonDMCHD group (n=155). The age, gender, blood pressure, blood lipid, ejection fraction (EF), the angiographic outcomes, etc. were analyzed and compared between the two groups.Results: The incidence of hypertension was significantly higher in the DMCHD group than in the nonDMCHD group (P<0.05). The fasting blood glucose (FBG), triglyceride (TG), low density lipoprotein cholesterol (LDLC), and fibrinogen (FIB) were significantly higher than those in the other group (P<0.01), and the high density lipoprotein cholesterol(HDLC) was lower than that in the other group (P<0.05).The EF value in the DMCHD group was significantly lower than that in the nonDMCHD group (P<0.01). Among the 35 (22%) patients preliminarily diagnosed as having DM, 14 (40%) would be misdiagnosed if the diagnosis depends solely on FBG without oral glucose tolerance test (OGTT). The prevalence of diffusive coronary lesions in the DMCHD group was significantly higher than that in the nonDM group (P<0.01). DMCHD group also had significantly higher coronary stenosis index (P<0.01) and more occlusive vessels than nonDMCHD group. Conclusion: The missed diagnosis rate of DM is high in CHD patients. Compared with nonDMCHD patients, DMCHD patients are at higher risks for coronary disease and have more severe coronary lesions. |
| Key words: coronary disease type 2 diabetes mellitus coronary angiograph insulin resistance aged |
