Ito Tsuyoshi, Ichihashi Taku, Fujita Hiroshi, Sugiura Tomonori, Yamamoto Junki, Kitada Shuichi, Nakasuka Kosuke, Kawada Yu, Ohte Nobuyuki
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
Heart Vessels. 2019 Aug;34(8):1250-1257. doi: 10.1007/s00380-019-01353-w. Epub 2019 Feb 2.
Impaired glucose metabolism is associated with an increased risk of cardiovascular complications, and coronary artery spasm is thought to underlie the development of coronary artery disease. Intraday glucose variability (GV) accelerates oxidative stress and inflammatory cytokine release, but its impact on coronary artery spasm remains unclear. This study investigated the relationship between intraday GV and coronary artery spasm. The study included 50 patients with dysglycemia and suspected coronary spastic angina. GV was analyzed by 24-h monitoring of the blood glucose concentration using a flash glucose monitoring system. The mean amplitude of glycemic excursion (MAGE) was calculated as an index of GV. Coronary artery spasm was assessed using the intracoronary acetylcholine provocation test. Coronary spasm was defined as acetylcholine-induced total or subtotal coronary occlusion. Changes in vessel diameter in response to acetylcholine were evaluated with quantitative coronary angiography. Coronary artery spasms were observed in 21 patients (42%). MAGE was significantly higher in patients with spasms compared to those without spasms (127.5 ± 33.5 vs. 91.4 ± 37.6, p < 0.01). Regression analysis showed a positive correlation between MAGE levels and coronary diameter changes induced by acetylcholine (r = 0.47, p < 0.01). In multiple regression analysis, MAGE was independently associated with acetylcholine-induced coronary diameter change (β = 0.47, p < 0.01). Intraday GV was associated with coronary artery spasm in patients with dysglycemia.
糖代谢受损与心血管并发症风险增加相关，冠状动脉痉挛被认为是冠状动脉疾病发生的基础。日内血糖变异性（GV）会加速氧化应激和炎性细胞因子释放，但其对冠状动脉痉挛的影响仍不明确。本研究调查了日内GV与冠状动脉痉挛之间的关系。该研究纳入了50例血糖异常且疑似冠状动脉痉挛性心绞痛的患者。使用动态血糖监测系统通过24小时监测血糖浓度来分析GV。计算血糖波动平均幅度（MAGE）作为GV的指标。使用冠状动脉内乙酰胆碱激发试验评估冠状动脉痉挛。冠状动脉痉挛定义为乙酰胆碱诱导的冠状动脉完全或次全闭塞。通过定量冠状动脉造影评估血管直径对乙酰胆碱的反应变化。21例患者（42%）观察到冠状动脉痉挛。痉挛患者的MAGE显著高于无痉挛患者（127.5±33.5对91.4±37.6，p<0.01）。回归分析显示MAGE水平与乙酰胆碱诱导的冠状动脉直径变化呈正相关（r=0.47，p<0.01）。在多元回归分析中，MAGE与乙酰胆碱诱导的冠状动脉直径变化独立相关（β=0.47，p<0.01）。日内GV与血糖异常患者的冠状动脉痉挛相关。
