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糖代谢正常冠心病患者的后期糖代谢变化对预后的影响
Influence of the Late Glucose Metabolism Change on the Prognosis in Patients Diagnosed Coronary Artery Disease with Normal Glucose Metabolism
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DOI:
作者:
罗瑞萍
Luo Ruiping
作者单位:
上海长宁区中心医院
Division of Cardiology, Shanghai Changning District Center Hospital, Shanghai 200336, China
关键词:
冠状动脉疾病; 糖尿病; 糖代谢异常; 预后
coronary artery disease; diabetes mellitus; abnormal glucose metabolism; prognosis
摘要:
目的 本研究对糖代谢正常的冠心病患者进行随访,观察远期患者糖代谢异常发生情况及其对预后的影响。方法 280例糖代谢正常的冠心病患者在住院期间及出院后进行简化口服葡萄糖耐量检查,随访其糖代谢的变化,并观察主要心血管事件(MACE)的发生率。结果 随访期间新发糖调节受损(IGR)32例(包括糖耐量受损(IGT)、空腹血糖受损(IFG)和IGT+IFG),占11.42%,发生率为6.04/100人年;新发糖尿病(DM)45例(DM组),占16.07%,发生率为8.50/100人年;糖代谢正常(NGM )203 例(NGM组),占 72.50 %。NGM组有47 例(23.15%)发生MACE,IGR组有13例(40.63%)发生MACE,DM组有 21 例(46.67%)发生MACE。IGR组及DM组的MACE发生率均较糖代谢正常组高,差异有显著性(P=0.0351 和P=0.0014)。多因素回归分析显示,年龄、男性、心肌梗死史及糖代谢异常是发生MACE的独立危险因素。结论 住院期间糖代谢正常的冠心病患者在病程中有较高比例的患者出现糖代谢异常,其预后比维持糖代谢正常者差,持续监测冠心病糖代谢情况可能具有重要的临床意义。
Objective To investigate the late glucose metabolism change and its impact on long-term outcomes of patients with coronary artery disease (CAD) and normal glucose metabolism(NGM). Methods Simplified oral glucose tolerance test(OGTT) was performed in 280 consecutive patients diagnosed CAD with NGM in our hospital before the discharge and every 6 months during the follow-up period. To record and compare the major adverse cardiac events (MACE) (include recurrent myocardial infarction, revascularization and cardiac death) in different groups. Results Mean follow-up duration was 22.70±13.42 months(ranged from 6 to 61months). Of 280 patients, 45 patients developed diabetes(16.07%) (DM group), 32 patients developed impaired glucose regulation(IGR)(including impaired glucose tolerance(IGT) 、impaired fasting glucose(IFG) and IGT+IFG)(11.42%),and 203 patients kept NGM (72.50%)(NGM group). With MACE occurred, there were 21 patients in DM group(46.67%), 13 patients in IGR group (40.63%)and 47 patients in NGM group(23.15%), respectively. Compared with NGM group, DM group and IGR group had higher incidence rate of MACE(P=0.0014 and P=0.0351, respectively). Logistic regression analysis showed that age, male, history of myocardial infarction and abnormal glucose metabolism were independent predictors of MACE. Conclusions Many patients diagnosed initially CAD with NGM develop into late abnormal glucose metabolism, and have rather worse prognosis. The glucose metabolic status should be evaluated at regular intervals in patients diagnosed CAD with NGM.
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