2型糖尿病一级亲与非一级亲冠状动脉病变程度的比较  

Comparison of the characteristics of coronary artery disease between first-degree relatives and non-firstdegree relatives of patients with type 2 diabetes

作　　者：顾卫琼[1] 张翼飞[1] 洪洁[1] 陈瑛[1] 张钰[1] 张豫文[1] 李小英[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病临床医学中心,上海市内分泌代谢病研究所,200025

出　　处：《中华内分泌代谢杂志》2009年第4期374-377,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：973国家重大基础研究计划项目子课题（2006CB503904）;国家自然科学基金（30725037）;上海市卫生局科研课题（2008065）

摘　　要：目的比较糖尿病一级亲和非一级亲冠心病的发生情况及冠状动脉病变程度。方法纳入2005年1月至2007年12月因急性心梗或因高度怀疑冠心病而入瑞金医院心内科行冠状动脉造影的所有1382例患者，用Gensini评分来评价冠状动脉病变的严重程度。SPSS统计软件分析糖尿病一级亲和非一级亲之间的各项指标差异。结果在正常血糖人群中，糖尿病一级亲组的腰臀比和稳态模型评估的胰岛素抵抗指数（HOMA—IR）显著高于非一级亲组（腰臀比，0．97±0．05那0．93±0．07，P〈0．01；HOMA—IR，2．54±1．08／）vs2．05±1．13，P〈0．01）。其冠心病确诊率以及Gensini评分亦显著升高[冠心病确诊率，75．0％vs56．1％，P=0．026；Gensini评分，20．00（2．75—35．25）vs5．00（0．00—20．00），P=0．006]。相对非一级亲，糖尿病一级亲发生冠心病的风险相对危险度为1．336（OR=1．336，95％C11．089—1．639）。在糖尿病人群中，平均糖尿病病程（7．2±6．3）年。一级亲组的餐后2h血糖和HbA1c水平显著高于非一级亲组，两组的冠心病确诊率及Gensini评分亦无显著差异。结论2型糖尿病一级亲在发生糖尿病前即表现出胰岛素敏感性降低，冠心病发生率升高和冠状动脉病变程度的加重，提示糖尿病一级亲不仅是冠心病的高危人群，而且有必要在早期就进行冠心病的筛查和预防。Objectives To investigate the effect of the family history of type 2 diabetes on the development of coronary artery disease （CAD） in first-degree relatives and non-first-degree relatives of diabetes. Methods A total of 1 382 subjects diagnosed as acute myocardial infarction or undergone coronary angiography in Ruijin Hospital since January 2005 to December 2007 were recruited into the study. The severity of coronary atherosclerosis was also estimated by Gensini cumulative index. The characteristics of CAD and biochemical indexes were compared between the first-degree relatives and non-first-degree relatives during stages with normal glucose tolerance and overt diabetes respectively. Results In the cases of nondiabetes, the waist-to-hip ratio （WHR） and homeostasis model assessment for insulin resistance （HOMA-IR） were significantly increased in the group of first-degree relatives （WHR,0.97±0.05 vs 0. 93±0.07 ,P〈0.01 ; HOMA-IR, 2.54±1.08 vs 2.05-±1.13,P〈0.01）. Furthermore, both the prevalence of CAD and the Gensini score were much higher [ prevalence 75.0% vs 56.1% , P = 0. 026 ; Gensini score 20.00 （2.75-35.25） vs 5.00（0.00-20.00）, P=0.006]. In the cases of diabetes, the mean duration of the disease was （7.2±6.3） year. Postprandial blood glucose and HbAlc were significantly increased in the first-degree relatives group. Either the prevalence of CAD or the Gensini score showed no difference between two groups. Conclusions During the stage of normal glucose tolerance, the first-degree relatives of patients with type 2 diabetes show insufficient insulin sensitivity. Moreover, they possess the clinical characteristics of raised incidence and severity of CAD. Since the first-degree relatives of patients with diabetes have high risk of CAD, it is necessary to regularly screen and prevent CAD in these people before diabetes sets in.

关 键 词：糖尿病 2型 一级亲 冠状动脉疾病 

分 类 号：R686[医药卫生—骨科学]