口服葡萄糖耐量试验可预测急性冠脉综合征患者颈动脉斑块负荷增加。
Oral glucose tolerance test predicts increased carotid plaque burden in patients with acute coronary syndrome.
作者信息
Bjarnason Thorarinn A, Hafthorsson Steinar O, Kristinsdottir Linda B, Oskarsdottir Erna S, Aspelund Thor, Sigurdsson Sigurdur, Gudnason Vilmundur, Andersen Karl
机构信息
Department of Medicine, Division of Cardiology, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland.
University of Iceland, School of Health Sciences, Reykjavik, Iceland.
出版信息
PLoS One. 2017 Aug 30;12(8):e0183839. doi: 10.1371/journal.pone.0183839. eCollection 2017.
BACKGROUND
Type 2 diabetes and prediabetes are established risk factors for atherosclerosis. The aim of this study was to evaluate the atherosclerotic plaque burden in the carotid arteries of patients with acute coronary syndrome according to their glycemic status.
METHODS
Patients with acute coronary syndrome and no previous history of type 2 diabetes were consecutively included in the study. Glucose metabolism was evaluated with fasting glucose in plasma, HbA1c and a standard two-hour oral glucose tolerance test. Atherosclerotic plaque in the carotid arteries was evaluated with a standardized ultrasound examination where total plaque area was measured and patients classified as having no plaque or a significant plaque formation.
RESULTS
A total of 245 acute coronary syndrome patients (male 78%, 64 years (SD: 10.9)) were included. The proportion diagnosed with normal glucose metabolism, prediabetes and type 2 diabetes was 28.6%, 64.1% and 7.3%, respectively. A significant atherosclerotic plaque was found in 48.5%, 66.9% and 72.2% of patients with normal glucose metabolism, prediabetes and type 2 diabetes, respectively. An incremental increase in total plaque area was found from normal glucose metabolism to prediabetes (25.5%) and from normal glucose metabolism to type 2 diabetes (35.9%) (p = 0.04). When adjusted for conventional cardiovascular risk factors the OR of having significant atherosclerotic plaque in the carotid arteries was 2.17 (95% CI 1.15-4.15) for patients with newly diagnosed dysglycemia compared to patients with normal glucose metabolism. When additionally adjusted for the 2-hour plasma glucose after glucose loading (2hPG) the OR attenuated to 1.77 (95% CI 0.83-3.84).
CONCLUSION
Newly detected dysglycemia is an independent predictor of significant atherosclerotic plaque in the carotid arteries with oral glucose tolerance test as a major determinant of carotid plaque burden in this group of individuals with acute coronary syndrome.
背景
2型糖尿病和糖尿病前期是动脉粥样硬化已确定的危险因素。本研究的目的是根据血糖状况评估急性冠状动脉综合征患者颈动脉的动脉粥样硬化斑块负荷。
方法
连续纳入无2型糖尿病既往史的急性冠状动脉综合征患者。通过检测空腹血浆葡萄糖、糖化血红蛋白（HbA1c）以及标准的两小时口服葡萄糖耐量试验来评估葡萄糖代谢情况。采用标准化超声检查评估颈动脉的动脉粥样硬化斑块，测量总斑块面积，并将患者分为无斑块或有显著斑块形成。
结果
共纳入245例急性冠状动脉综合征患者（男性占78%，年龄64岁（标准差：10.9））。诊断为葡萄糖代谢正常、糖尿病前期和2型糖尿病的患者比例分别为28.6%、64.1%和7.3%。葡萄糖代谢正常、糖尿病前期和2型糖尿病患者中分别有48.5%、66.9%和72.2%发现有显著的动脉粥样硬化斑块。从葡萄糖代谢正常到糖尿病前期总斑块面积增加了25.5%，从葡萄糖代谢正常到2型糖尿病增加了35.9%（p = 0.04）。与葡萄糖代谢正常的患者相比，新诊断为血糖异常的患者在调整传统心血管危险因素后，颈动脉有显著动脉粥样硬化斑块的比值比（OR）为2.17（95%置信区间1.15 - 4.15）。在额外调整葡萄糖负荷后2小时血浆葡萄糖（2hPG）后，OR降至1.77（95%置信区间0.83 - 3.84）。
结论
新检测到的血糖异常是颈动脉显著动脉粥样硬化斑块的独立预测因素，在这组急性冠状动脉综合征患者中，口服葡萄糖耐量试验是颈动脉斑块负荷的主要决定因素。
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