糖化血红蛋白对冠状动脉血运重建患者心脏功能的影响。
Effect of glycated hemoglobin on heart function of the patients with revascularization of coronary artery.
作者信息
Sun X Q, Bao B N, Gao X Y, Yan D E, Zhou Y S
机构信息
Department of Endocrinology & Metabolism, Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing, China.
Department of Endocrinology & Metabolism, Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing, China ; Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing, China.
出版信息
Int J Clin Exp Pathol. 2015 Jun 1;8(6):7181-8. eCollection 2015.
BACKGROUND
Patients with diabetes after coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) treatment for coronary artery disease (CAD) had higher mortality rates than those without diabetes. There were limited data comparing the cardiac and metabolic differences between diabetes and non-diabetes for CABG and PCI and about impact of pre-procedure GHb level on systolic heart function in patients with diabetes.
AIMS
To explore the cardio-metabolic differences and to evaluate their potential as significant risk factors.
SUBJECTS AND METHOD
124 patients with diabetes and 170 patients without diabetes were enrolled. Coronary lesions (≥ 70% stenosis in at least one major coronary artery) were documented by angiography. Patients with diabetes were divided into different groups by GHb, Coronary lesions (≥ 70% stenosis in at least one major coronary artery) were documented by angiography. CABG and PCI were performed for all the patients. Cardio-metabolic risk factors before revascularization were compared between them.
RESULTS
Diabetics with GHb ≥ 8% had lower cardiac ejection fraction (EF) values than those with GHb<8% (P<0.05) or patients without diabetes (P<0.05). And count of vascular lesions between the groups was not statistically significant. Observed EF as a dependent variable negatively correlated to GHb levels (P<0.05). The levels of glycated hemoglobin A1c (GHbA1c) rose with increased fasted blood glucose (FBG) values (P<0.001). Even with treatment for hyperglycemia and dyslipidemia, overall levels of fasting blood sugar (FBG, P<0.001), GHbA1c (P<0.001), and triglycerides (TG, P<0.05) in patients with diabetes were still higher than those without diabetes respectively.
CONCLUSION
Poorer glucose control with GHb ≥ 8% and decreased systolic heart function are significant risk factors that potentially contribute to worse prognosis for CABG or PCI treatment. Elevated levels of FBG, GHbA1c, and TG are evident for patients with diabetes compared to patients without diabetes prior to revascularization.
背景
接受冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）的冠心病（CAD）糖尿病患者的死亡率高于非糖尿病患者。关于CABG和PCI中糖尿病与非糖尿病患者心脏和代谢差异的数据有限，且关于术前糖化血红蛋白（GHb）水平对糖尿病患者收缩期心脏功能影响的数据也有限。
目的
探讨心脏代谢差异并评估其作为重要危险因素的可能性。
研究对象与方法
纳入124例糖尿病患者和170例非糖尿病患者。通过血管造影记录冠状动脉病变（至少一支主要冠状动脉狭窄≥70%）。糖尿病患者按GHb水平分组，通过血管造影记录冠状动脉病变（至少一支主要冠状动脉狭窄≥70%）。所有患者均接受CABG和PCI治疗。比较血运重建术前两组患者的心脏代谢危险因素。
结果
GHb≥8%的糖尿病患者的心脏射血分数（EF）值低于GHb<8%的患者（P<0.05）或非糖尿病患者（P<0.05）。且各组间血管病变数量无统计学差异。将观察到的EF作为因变量与GHb水平呈负相关（P<0.05）。糖化血红蛋白A1c（GHbA1c）水平随空腹血糖（FBG）值升高而升高（P<0.001）。即使进行了高血糖和血脂异常治疗，糖尿病患者的空腹血糖（FBG，P<0.001）、GHbA1c（P<0.001）和甘油三酯（TG，P<0.05）总体水平仍分别高于非糖尿病患者。
结论
GHb≥8%时血糖控制较差和收缩期心脏功能下降是可能导致CABG或PCI治疗预后较差的重要危险因素。与血运重建术前的非糖尿病患者相比，糖尿病患者的FBG、GHbA1c和TG水平明显升高。
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