Johansen O E, Birkeland K I, Brustad E, Aaser E, Lindahl A K, Midha R, Ueland T, Aukrust P, Gullestad L
Diabetic Out-Patient Clinic, Medical Department, Asker and Baerum Hospital, RUD, Oslo, Norway.
Eur J Clin Invest. 2006 Aug;36(8):544-51. doi: 10.1111/j.1365-2362.2006.01679.x.
Cardiovascular (CV) disease is associated with increased levels of glucose, but the prevalence of dysglycaemia in CV diseases is not fully known. The study examined the prevalence of unknown dysglycaemia and its association with inflammation in Caucasian patients with ischaemic vascular complications, i.e. coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral artery disease (PAD).
This case-controlled study involved 149 patients (mean age 68 years) hospitalized for CAD, PAD or CVD and 59 control-subjects (CTR) free from CV-disease. The prevalence of dysglycaemia according to WHO/ADA criteria (impaired fasting glycaemia, impaired glucose tolerance or diabetes mellitus) was assessed by a 75-g oral glucose tolerance test. Inflammatory parameters were analyzed in fasting samples.
Dysglycaemia was found in 49%, 55% and 57% of patients with CAD, CVD and PAD, respectively; all were significantly higher than among the controls (29%). The odds ratio (95% CI) for being dysglycaemic were 1.7 (1.04-2.77), 1.9 (1.19-3.06) and 2.0 (1.25-3.19) for CAD, CVD and PAD, respectively. Inflammatory markers (the total leucocyte count, soluble tumour necrosis factor-receptor type I, C-reactive protein) were elevated in patient groups and tended to increase with increasing blood glucose levels in all groups. The levels of the anti-inflammatory cytokine transforming growth factor-beta1 and insulin-like growth factor binding protein 3 were lowered in patients with CAD and, in patients with PAD, the former was inversely related to the levels of the blood glucose.
Undiagnosed dysglycaemia was common in patients with ischaemic CV manifestations regardless of vascular bed involved. Inflammation was associated in a dosage-related manner to glucose levels.
心血管（CV）疾病与血糖水平升高相关，但心血管疾病中血糖异常的患病率尚不完全清楚。本研究调查了患有缺血性血管并发症的白种人患者，即冠状动脉疾病（CAD）、脑血管疾病（CVD）和外周动脉疾病（PAD）中未被诊断出的血糖异常患病率及其与炎症的关联。
这项病例对照研究纳入了149例因CAD、PAD或CVD住院的患者（平均年龄68岁）以及59例无心血管疾病的对照受试者（CTR）。根据世界卫生组织/美国糖尿病协会标准（空腹血糖受损、葡萄糖耐量受损或糖尿病），通过75克口服葡萄糖耐量试验评估血糖异常的患病率。在空腹样本中分析炎症参数。
CAD、CVD和PAD患者中血糖异常的发生率分别为49%、55%和57%；均显著高于对照组（29%）。CAD、CVD和PAD患者血糖异常的比值比（95%可信区间）分别为1.7（1.04 - 2.77）、1.9（1.19 - 3.06）和2.0（1.25 - 3.19）。患者组的炎症标志物（白细胞总数、可溶性肿瘤坏死因子受体I型、C反应蛋白）升高，且在所有组中均倾向于随血糖水平升高而增加。CAD患者中抗炎细胞因子转化生长因子-β1和胰岛素样生长因子结合蛋白3的水平降低，在PAD患者中，前者与血糖水平呈负相关。
无论涉及何种血管床，未被诊断出的血糖异常在有缺血性心血管表现的患者中都很常见。炎症与血糖水平呈剂量相关。
