2018 年第 10 期 第 13 卷

非ST段抬高型急性冠状动脉综合征合并糖尿病患者不同血糖指标与复杂冠状动脉病变及不良预后的关系

Relation of glycemic markers with complex coronary artery lesions and adverse cardiovascular outcomes in non-ST segment elevation acute coronary syndrome patients with diabetes mellitus

作者：赵奇黄觊张婷玉候雪见马越闫贤良张京梅李志忠

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科十五病房

英文单位：

关键词：急性冠状动脉综合征；糖化血红蛋白；糖化血清白蛋白；空腹血糖；复杂冠状动脉病变；糖尿病

英文关键词：

• 摘要：

• 【摘要】目的    分析非ST段抬高型急性冠状动脉综合征合并糖尿病患者不同血糖指标与复杂冠状动脉病变和经皮冠状动脉介入术后不良心血管预后的关系。方法    回顾性分析2015年7月至2016年8月首都医科大学附属北京安贞医院收治的404例非ST段抬高型急性冠状动脉综合征（NSTE-ACS）合并糖尿病患者的病历资料。每例患者入院后均接受了冠状动脉造影和经皮冠状动脉介入治疗，并在住院期间测量了糖化血红蛋白（HbA1c）、糖化血清白蛋白（GA）和空腹血糖水平，出院后进行了1年随访。复杂冠状动脉病变包括多支病变、慢性完全闭塞病变、完全闭塞病变、弥漫性病变、分叉病变。结果    复杂冠状动脉病变组（300例）血清HbA1c、GA、空腹血糖水平均明显高于非复杂冠状动脉病变组（104例）［（7.6±1.2）%比（7.0±1.1）%、（19±4）%比（18±4）%、（7.7±2.4）mmol/L比（7.1±2.1）mmol/L］（均P＜0.05）。HbA1c、GA、空腹血糖水平与复杂冠状动脉病变均有明显相关性（r＝0.240、P＜0.001； r＝0.148、P＜0.01； r＝0.134、P＜0.01）。HbA1c、GA、空腹血糖对于诊断复杂冠状动脉病变的ROC曲线下面积分别为0.650（P＜0.001）、0.598（P＝0.004）、0.584（P＝0.013）。HbA1c是复杂冠状动脉病变的独立危险因素（比值比＝1.805，95%置信区间：1.216～2.680，P＝0.003）。HbA1c＞7.0%（风险比＝4.293，95%置信区间：1.874～9.839，P＜0.01）和GA＞18%（风险比＝1.986，95%置信区间：1.036～3.807，P＜0.05）是1年心血管不良事件的独立危险因素。结论    HbA1c水平升高是NSTE-ACS合并糖尿病患者复杂冠状动脉病变的独立预测因素。相较于GA和空腹血糖，高水平HbA1c对复杂冠状动脉病变及短期不良心血管预后的预测价值较高。

• 【Abstract】Objective    To analyze the relation of glycemic markers with complex coronary artery lesion and adverse cardiovascular outcomes in non-ST segment elevation acute coronary syndrome（NSTE-ACS） patients with diabetes mellitus(DM). Methods    Clinical records of 404 NSTE-ACS patients with DM admitted to Beijing Anzhen Hospital, Capital Medical University from July 2015 to August 2016 were retrospectively analyzed. All patients had coronary angiography, percutaneous coronary intervention and their glycosylated hemoglobin(HbA1c), glycated albumin(GA) and fasting blood glucose(FBG) measured during hospitalization. They were followed up for 1 year after discharge. Complex coronary artery lesions included multi-vessel lesion, chronic total occlusion lesion, total occlusion lesion, long diffuse lesion and bifurcation lesion. Results    Serum levels of HbA1c, GA and FBG in complex coronary artery lesion group（n＝300） were significantly higher than those in non-complex coronary artery lesion group（n＝104）［（7.6±1.2）% vs （7.0±1.1）%, （19±4）% vs （18±4）%, （7.7±2.4）mmol/L vs （7.1±2.1）mmol/L］（P＜0.05）. HbA1c, GA and FBG were positively correlated with complex coronary artery lesions（r＝0.240, P＜0.001； r＝0.148, P＜0.01； r＝0.134, P＜0.01）. Areas under ROC curve of HbA1c, GA and FBG were 0.650（P＜0.001）, 0.598（P＝0.004）, 0.584（P＝0.013）, respectively. HbA1c was an independent predictor of complex coronary artery lesions(odds ratio＝1.805， 95% confidence interval： 1.216-2.680， P＝0.003）. HbA1c>7.0%( hazard ratio＝4.293， 95% confidence interval： 1.874-9.839， P＜0.01） and GA>18%（hazard ratio＝1.986， 95% confidence interval： 1.036-3.807， P＜0.05） were independent risk factors of 1-year adverse cardiovascular outcomes. Conclusions    Elevated HbA1c level is an independent predictor of complex coronary artery lesions in NSTE-ACS patients with DM. Serum HbA1c level is a better indicator than GA and FBG in the prediction of complex coronary lesions and short-term adverse cardiovascular outcomes.