Bartnik M, Rydén L, Malmberg K, Ohrvik J, Pyörälä K, Standl E, Ferrari R, Simoons M, Soler-Soler J
Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Heart. 2007 Jan;93(1):72-7. doi: 10.1136/hrt.2005.086975. Epub 2006 Aug 11.
Patients with coronary artery disease (CAD) and abnormal glucose regulation (AGR) are at high risk for subsequent cardiovascular events, underlining the importance of accurate glucometabolic assessment in clinical practice.
To investigate different methods to identify glucose disturbances among patients with acute and stable coronary heart disease.
Consecutive patients referred to cardiologists were prospectively enrolled at 110 centres in 25 countries (n = 4961). Fasting plasma glucose (FPG) and glycaemia 2 h after a 75-g glucose load were requested in patients without known glucose abnormalities (n = 3362). Glucose metabolism was classified according to the World Health Organization and American Diabetes Association (ADA; 1997, 2004) criteria as normal, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes.
Data on FPG and 2-h post-load glycaemia were available for 1867 patients, of whom 870 (47%) had normal glucose regulation, 87 (5%) had IFG, 591 (32%) had IGT and 319 (17%) had diabetes. If classification had been based on the ADA criterion from 1997, the proportion of misclassified (underdiagnosed) patients would have been 39%. The ADA 2004 criterion would have overdiagnosed 8% and underdiagnosed 33% of the patients, resulting in a total misclassification rate of 41%. For ethical concerns and practical reasons, oral glucose tolerance test (OGTT) was not conducted in 1495 of eligible patients. These patients were more often women, had higher age and waist circumference, and were therefore more likely to have AGR than those who were included. A model based on easily available clinical and laboratory variables, including FPG, high-density lipoprotein cholesterol, age and the logarithm of glycated haemoglobin A1c, misclassified 44% of the patients, of whom 18% were overdiagnosed and 26% were underdiagnosed.
An OGTT is still the most appropriate method for the clinical assessment of glucometabolic status in patients with coronary heart disease.
冠状动脉疾病（CAD）合并糖调节异常（AGR）的患者发生后续心血管事件的风险很高，这突出了临床实践中准确评估糖代谢的重要性。
研究在急性和稳定型冠心病患者中识别糖代谢紊乱的不同方法。
在25个国家的110个中心前瞻性纳入心内科转诊的连续患者（n = 4961）。对无已知糖代谢异常的患者（n = 3362）检测空腹血糖（FPG）和75 g葡萄糖负荷后2小时血糖。根据世界卫生组织和美国糖尿病协会（ADA；1997年、2004年）标准将糖代谢分为正常、空腹血糖受损（IFG）、糖耐量受损（IGT）或糖尿病。
1867例患者有FPG和负荷后2小时血糖数据，其中870例（47%）糖代谢正常，87例（5%）有IFG，591例（32%）有IGT，319例（17%）有糖尿病。若根据1997年ADA标准进行分类，误诊（漏诊）患者比例为39%。2004年ADA标准会使8%的患者被过度诊断，33%的患者被漏诊，总误诊率为41%。出于伦理考虑和实际原因，1495例符合条件的患者未进行口服葡萄糖耐量试验（OGTT）。这些患者女性更多，年龄和腰围更大，因此比纳入试验的患者更易出现AGR。基于易于获得的临床和实验室变量（包括FPG、高密度脂蛋白胆固醇、年龄和糖化血红蛋白A1c的对数）构建的模型误诊了44%的患者，其中18%被过度诊断，26%被漏诊。
OGTT仍是冠心病患者糖代谢状态临床评估的最合适方法。
