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70岁以上2型糖尿病合并冠心病患者临床指标和冠状动脉造影分析
刘夙璇,秦永文*,游晓华
0
(第二军医大学长海医院心血管内科,上海 200433)
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(DMCHD)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:DMCHD组合并高血压的发病率明显高于NDMCHD组(P<0.05),其空腹血糖(FBG)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDLC)、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(HDLC)低于NDMCHD组(P<0.05);DMCHD组左室射血分数(EF)显著低于NDMCHD组(P<0.01)。155例DMCHD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%)。DMCHD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;DMCHD较之NDMCHD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:
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 angiographconfirmed 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: DMCHD group (n=155) and nonDMCHD 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 DMCHD group than in the nonDMCHD group (P<0.05). The fasting blood glucose (FBG), triglyceride (TG), low density lipoprotein cholesterol (LDLC), and fibrinogen (FIB) were significantly higher than those in the other group (P<0.01), and the high density lipoprotein cholesterol(HDLC) was lower than that in the other group (P<0.05).The EF value in the DMCHD group was significantly lower than that in the nonDMCHD 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 DMCHD group was significantly higher than that in the nonDM group (P<0.01). DMCHD group also had significantly higher coronary stenosis index (P<0.01) and more occlusive vessels than nonDMCHD group. Conclusion: The missed diagnosis rate of DM is high in CHD patients. Compared with nonDMCHD patients, DMCHD 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