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目的 探讨早期糖代谢异常对冠状动脉 (冠脉 )血流储备的影响。方法 包括 2 5例糖耐量异常的胸痛但冠脉造影正常患者 (糖耐量异常组 )及 2 5例血糖正常且年龄、性别及一般情况匹配、冠脉造影正常的患者 (对照组 )。比较两组的血糖、胰岛素、糖化血红蛋白、纤维蛋白原、C 反应蛋白水平及冠脉血流储备功能。结果 糖耐量异常组空腹及糖耐量试验餐后 2h血糖显著高于对照组[分别为 :(6 5 4± 0 2 2 )mmol/L与 (5 18± 0 6 6 )mmol/L ;(10 6 3± 3 2 6 )mmol/L与 (9 0 9± 1 89)mmol/L ,P均 <0 0 0 1],前者糖化血红蛋白明显增高 [(6 32± 0 6 7) %与 (5 5 4± 1 2 3) %,P <0 0 5 ]。与对照组比较 ,糖耐量异常组基础冠脉血流平均峰值流速显著增高 [(2 2 6± 5 6 )cm/s与 (17 9± 4 9)cm/s,P <0 0 5 ],但腺苷激发后冠脉血流平均峰值流速 [(4 7 1± 13 8)cm/s与 (6 0 7± 15 3)cm/s ,P <0 0 5 ]和冠脉血流储备 (2 0 9± 0 31与 3 4 2± 0 5 5 ,P <0 0 0 1)显著减低。结论 早期糖代谢异常时 ,冠脉造影正常 ,但其冠脉血流储备常常减低。
Objective To investigate the effect of early abnormal glucose metabolism on coronary blood flow reserve. METHODS: Twenty-five patients with normal glucose tolerance (IGT) and 25 patients with normal glucose tolerance (IGT) and normal glucose tolerance patients (control group) with normal blood glucose and matched for age, sex and general condition were included. Blood glucose, insulin, glycosylated hemoglobin, fibrinogen, C-reactive protein and coronary flow reserve were compared between the two groups. Results Fasting plasma glucose and glucose tolerance test in patients with impaired glucose tolerance group were significantly higher than those in the control group at 2h after meal ([6 5 4 ± 0 2 2] mmol / L and (5 18 ± 0 6 6) mmol / L, respectively; 6 3 ± 3 2 6) mmol / L and (9 0 9 ± 1 89) mmol / L, P 0 0 01, respectively. The former HbA1c significantly increased [(6 32 ± 0 6 7)% vs 5 4 ± 1 2 3)%, P <0 0 5]. Compared with the control group, the mean peak flow velocity of basilar coronary artery was significantly higher in patients with impaired glucose tolerance ([(226 ± 56) cm / s vs (179 ± 499 cm / s, P <0 05] However, the mean peak flow velocity of coronary blood flow after stimulation with adenosine was (471 ± 13 8) cm / s and (60 7 ± 15 3) cm / s, P 0 05 and coronary flow reserve 2 0 9 ± 0 31 and 3 4 2 ± 0 5 5, P 0 01 0). Conclusion Early abnormal glucose metabolism, coronary angiography is normal, but coronary blood flow reserve is often reduced.