合并2型糖尿病的急性冠脉综合征患者GRACE评分与冠脉病变严重程度的相关性研究  

The correlation between GRACE risk score and the severity of coronary artery disease in patients with acute coronary syndrome and type 2 diabetes mellitus

作　　者：白春兰[1] 张军[1] 牛和平[2] 

机构地区：[1]河北医科大学研究生学院,河北省石家庄市050000 [2]河北医科大学附属沧州市中心医院心内5科

出　　处：《中国心血管病研究》2016年第3期242-246,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨GRACE评分与合并2型糖尿病的急性冠脉综合征（ACS）患者冠状动脉病变相关性及相关程度。方法选取2014年1-12月在沧州市中心医院住院治疗的合并2型糖尿病的ACS患者262例，对所有患者行全球急性冠脉综合征注册评分（GRACE评分），根据评分结果分为低危组、中危组和高危组，比较三组患者临床参数差异。所有患者均行冠脉造影术，并根据造影结果采用Gensini积分对冠脉病变程度进行量化评价，同时记录冠脉病变支数，用Spearman相关分析GRACE评分与冠脉病变的关系，并用ROC曲线分析GRACE评分对三支或左主干病变的预测价值。结果三组年龄、心率、入院随机血糖、空腹血糖、低密度脂蛋白（LDL）、心肌标志物、糖尿病病程、冠脉病变支数、弥漫性病变和Gensini积分比较差异均有统计学意义。Spearman相关分析显示，GRACE评分与Gensini积分呈正相关（r=0．651，P〈0．01），GRACE评分危险分层与冠脉病变支数呈正相关（r=0．695，P〈0．01），GRACE评分（ROC曲线下面积0．870，95％CI0．826-0．914，P〈0．01）比糖尿病病程（ROC曲线下面积0．627，95％CI0．558-0．696，P〈0．01）对三支或左主干病变更有预测价值。结论GRACE评分对急性冠脉综合征合并2型糖尿病患者的冠脉病变支数和病变程度有较好的预测价值。Objective To evaluate the relationship between the Global Registry of Acute Coronary Events （GRACE） score and severity of coronary artery disease in patients with acute coronary syndrome（ACS） and type 2 diabetes mellitus（DM）. Methods a total of 262 patients with ACS and DMs were enrolled to the study from January to December 2014. Based on the GRACE risk score classification system, these patients were divided into low（n = 81） ,intermediate（n = 94）, and high risk（n=87）groups. All patients underwent coronary angiography ,the severity of coronary artery disease angiographically evaluated by Gensini score .The different of the severity and numbers of the pathological arteriers among groups were compared, the spearman correlation was used to analyze the Gensini score with GRACE risk score and the munbers of the of the pathological arteriers with the three groups. The receiver operating characteristic curve（ROC） was used to predict left main or three-vessel lesion. Results：the three groups had statistically different on the age、heart rate、fasting and admission blood glucose、LDL 、cardiac markers、disease duration of DM、the number of the pathological arteriers、diffuse coronary artery lesion and Gensini score. The Gensini scores are positively related with GRACE risk score（r =0.651 ,R〈0.001）,and the groups of the GRACE risk score are positively related with the munber of the of the pathological arteriers. GRACE risk score could predict three-vessel or left-main lesion（area under the ROC curve 0.870,95%CI=0.826-0.914;P〈0.001）, and the Predicted value was better than the disease duration of DM （area under the ROC curve 0.627,95%CI=0.558-0.696;P〈0.001）. Conclusion the GRACE score has significant value for assessing the severity and extent of coronary artery diseases in patients with ACS and DM.

关 键 词：急性冠脉综合征 糖尿病 全球急性冠脉综合征注册评分 冠状动脉病变 

分 类 号：R543.3[医药卫生—心血管疾病]