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目的探讨2型糖尿病冠心病患者的临床特征和冠状动脉造影特点。方法357例经冠状动脉造影确诊冠心病的患者,根据1999年WHO标准分为2型糖尿病冠心病组189例,单纯冠心病组168例,对所有研究对象均进行口服75g葡萄糖耐量试验,检测血糖、胰岛素、HbA_(1C)、血脂、24 h尿白蛋白/肌酐比值(24 h-Alb/Cr),采用稳态模型计算胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-IS)。对比分析两组患者的临床和冠状动脉造影资料。结果与单纯冠心病组比较,2型糖尿病冠心病组HOMA-IR和24 h-Alb/Cr明显增高(均P<0.05),HOMA-IS明显降低(P<0.01)。2型糖尿病冠心病组发生3支病变较多(P<0.05),冠状动脉重度狭窄、完全闭塞、弥漫病变比例较高(P<0.05或P<0.01),冠状动脉病变程度总评分较高(P<0.01)。结论2型糖尿病冠心病组冠状动脉病变累及范围广且程度重。
Objective To investigate the clinical features and coronary angiography features of type 2 diabetic patients with coronary heart disease. Methods A total of 357 patients with coronary heart disease diagnosed by coronary angiography were divided into two groups according to the 1999 WHO standard: 189 patients with type 2 diabetes and 168 patients with coronary heart disease. All subjects were given oral glucose tolerance test (75g) and blood glucose (HOMA-IR) and insulin secretion index (HOMA-IS) were calculated using steady-state model. The levels of insulin, HbA 1c, blood lipid and 24 h urinary albumin / creatinine were calculated. The clinical and coronary angiographic data were compared between the two groups. Results Compared with CHD group, HOMA-IR and 24 h-Alb / Cr in type 2 diabetes mellitus were significantly increased (all P <0.05) and HOMA-IS was significantly lower (P <0.01). There were 3 lesions in type 2 diabetic patients with coronary heart disease (P <0.05), severe coronary stenosis, complete occlusion, higher prevalence of diffuse lesions (P <0.05 or P <0.01) and higher severity of coronary lesions P <0.01). Conclusions Coronary artery lesions in type 2 diabetes mellitus have a wide range and severity of coronary lesions.