稳定型冠状动脉疾病非糖尿病患者的葡萄糖代谢

Glucose metabolism in non-diabetic patients with stable coronary artery disease.

作者信息

Santos José Ferreira, Almeida Manuel, Ferreira Jorge, Gonçalves Pedro, Raposo Luís, Teles Rui, Branco João, Catroga Teresa, Machado Francisco Pereira, Silva Aniceto

机构信息

Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal.

出版信息

Rev Port Cardiol. 2006 Jan;25(1):39-53.

PMID:16623355

Abstract

BACKGROUND

Diabetes and other forms of impaired glucose metabolism (IGM) can be present in patients with coronary artery disease (CAD), despite normal fasting glycemia and no prior evidence of diabetes. Undiagnosed IGM can be associated with increased risk of cardiovascular events.

OBJECTIVE

To assess the prevalence of IGM in patients with CAD and without diabetes and to identify its repercussions on their cardiovascular risk profile.

METHODS

Consecutive patients with CAD documented by angiography, without prior history of diabetes and fasting glycemia < 126 mg/dL, were studied. An oral glucose tolerance test (OGTT) was performed to identify and classify IGM. The patients were divided into three groups: normal if fasting glycemia < 100 mg/dL and normal OGTT; prediabetes if fasting glycemia > or = 100 mg/dL and abnormal OGTT, with 2-h glycemia > or = 140 and < 200 mg/dL; and diabetes if 2-h glycemia > or = 200 mg/dL after OGTT. For assessment of the cardiovascular risk profile, various clinical, laboratorial (including lipid profile, fasting insulinemia 2 h after OGTT, insulin resistance index and A1c hemoglobin) and angiographic characteristics were analyzed. The differences between groups were determined.

RESULTS

54 patients were studied (mean age 65 +/- 9 years, 78 % male) and IGM was identified in 37 (69%), with prediabetes in 23 (43%) and diabetes in 14 (26%). Patients with IGM had more dyslipidemia, higher levels of fasting glycemia, triglycerides and urea and lower HDL cholesterol. Metabolic syndrome was diagnosed in 12% of patients in the normal group, 44% in the prediabetes group and 50% in the diabetes group (p = 0.047). CAD was more severe in the presence of IGM, being multivessel in 84% of these patients versus 59% in the normal group (p = 0.046).

CONCLUSION

In patients with CAD without clinical suspicion of diabetes, a routine OGTT can identify a significant percentage with prediabetes and diabetes, which can have a negative impact on their cardiovascular risk profile.

摘要

背景

冠状动脉疾病（CAD）患者中可能存在糖尿病及其他形式的糖代谢受损（IGM），即便空腹血糖正常且既往无糖尿病证据。未诊断出的IGM可能与心血管事件风险增加相关。

目的

评估无糖尿病的CAD患者中IGM的患病率，并确定其对心血管风险状况的影响。

方法

对经血管造影证实患有CAD、无糖尿病病史且空腹血糖<126 mg/dL的连续患者进行研究。进行口服葡萄糖耐量试验（OGTT）以识别和分类IGM。患者分为三组：空腹血糖<100 mg/dL且OGTT正常为正常组；空腹血糖≥100 mg/dL且OGTT异常，2小时血糖≥140且<200 mg/dL为糖尿病前期组；OGTT后2小时血糖≥200 mg/dL为糖尿病组。为评估心血管风险状况，分析了各种临床、实验室指标（包括血脂谱、OGTT后2小时空腹胰岛素血症、胰岛素抵抗指数和糖化血红蛋白）及血管造影特征。确定组间差异。

结果

研究了54例患者（平均年龄65±9岁，78%为男性），其中37例（69%）被诊断为IGM，23例（43%）为糖尿病前期，14例（26%）为糖尿病。IGM患者血脂异常更多，空腹血糖、甘油三酯和尿素水平更高，高密度脂蛋白胆固醇更低。正常组12%的患者、糖尿病前期组44%的患者和糖尿病组50%的患者被诊断为代谢综合征（p = 0.047）。存在IGM时CAD更严重，这些患者中84%为多支血管病变，而正常组为59%（p = 0.046）。