2型糖尿病和非糖尿病患者冠脉病变进展的影响因素对比  

Comparison of Risk Factors for the Progression of Coronary Lesions in Patients with Type 2 Diabetes and Non-diabetes Mellitus

作　　者：温哲琦 汤磊乐 税星[1] 郑坚锐 陈璘[1] WEN Zhe-qi;TANG Lei-le;SHUI Xing;ZHENG Jian-rui;CHEN Lin(Department of Cardiovascular Medicine,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院心血管内科

出　　处：《中山大学学报（医学版）》2019年第6期912-920,共9页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2011B080701005)

摘　　要：【目的】探讨2型糖尿病(T2DM)与非糖尿病(NDM)患者冠脉病变进展的相关影响因素的异同。【方法】入选2001年3月至2017年1月期间于中山大学附属第三医院进行两次冠脉影像学检查(冠脉造影或冠脉CTA)的T2DM患者526例,NDM患者425例。平行分析各心血管危险因素对两类患者冠脉病变进展的影响。【结果】影响T2DM冠脉病变进展的正性因素包括吸烟(OR=1.836,95%CI:1.030~3.371,P=0.04)、基线脂蛋白a[Lp(a)](OR=1.001,95%CI:1.000~1.002,P=0.004)、复查Lp(a)(OR=1.001,95%CI:1.000~1.002,P=0.009)、复查糖化血红蛋白(HbA1c)分层(OR=1.471,95%CI:1.030~2.100,P=0.034)、复查低密度脂蛋白胆固醇(LDL-C)未达标(OR=1.882,95%CI:1.091~3.245,P=0.023)、复查总胆固醇(TC)(OR=2.029,95%CI:1.028~4.008,P=0.041),而负性影响因素为复查高密度脂蛋白胆固醇(HDL-C)(OR=0.017,95%CI:0.040~0.729,P=0.017)。影响NDM冠脉病变进展的正性因素包括基线体质量指数(BMI)(OR=1.746,95%CI:2.462~2.712,P=0.026)、复查BMI(OR=0.001,95%CI:0~0.394,P=0.025)、复查LDL-C未达标(OR=2.875,95%CI:1.669~4.952,P<0.001),而基线载脂蛋白A(ApoA)(OR=0.282,95%CI:0.082~0.971,P=0.045)、复查ApoA(OR=0.117,95%CI:0.038~0.835,P=0.029)则呈负性影响。T2DM患者基线及复查时血糖控制严格组(HbA1c<6.5%)冠脉病变进展程度最低[0(0~3.4)分/年vs 0.3(0~3.0)分/年vs 1.0(0~5.1)分/年,P=0.049;0(-0.4~2.7)分/年vs 0.6(0~4.0)分/年vs 0.9(0~4.2)分/年,P=0.029]。【结论】除LDL-C的达标情况是共同因素以外,2型糖尿病与非糖尿病患者冠脉病变进展的影响因素存在一定差异。吸烟、基线Lp(a)水平及复查时TC、HDL-C、Lp(a)、HbA1c控制层次是T2DM冠脉病变进展的独立预测因素。BMI、ApoA是非糖尿病冠脉病变进展的独立预测因素。控制HbA1c<6.5%可延缓T2DM冠脉病变进展程度。【Objective】Diabetes mellitus is a risk equivalent for coronary heart disease.This retrospective study was designed to investigate the risk factors of the progression of coronary lesions in patients with type 2 diabetes(T2DM)and Non-diabetes Mellitus(NDM).【Methods】526 patients with T2DM and 425 patients with NDM at the Third Affiliated Hospital of Sun Yat-sen University between March 2001 and January 2017 who underwent coronary imaging studies(coro?nary angiography or coronary CTA)twice during the same period were enrolled.The effects of cardiovascular risk factors on the progression of coronary lesions were analyzed in parallel in these two types of patients.【Results】Risk factors of the progression of coronary lesions in T2DM patients included smoking(OR=1.836,95%CI:1.030~3.371,P=0.04),Lp(a)[OR=1.001,95%CI:1.000~1.002,P=0.004(baseline);OR=1.001,95%CI:1.000~1.002,P=0.009(re-exam?ined)],HbA1c level[OR=1.471,95%CI:1.030~2.100,P=0.034(re-examined)],uncontrolled LDL-C(OR=1.882,95%CI:1.091~3.245,P=0.023),TC[OR=2.029,95%CI:1.028~4.008,P=0.041(re-examined)]and low HDL-C[OR=0.017,95%CI:0.040~0.729,P=0.017(re-examined)].Comparative risk factors in NDM included BMI[OR=1.746,95%CI:2.462~2.712,P=0.026(baseline);OR=0.001,95%CI:0~0.394,P=0.025(re-examined)],uncon?trolled LDL-C(OR=2.875,95%CI:1.669~4.952,P<0.001)and low ApoA[OR=0.282,95%CI:0.082~0.971,P=0.045(baseline);OR=0.117,95%CI:0.038~0.835,P=0.029(re-examined)].Lowest level of progression was found in the group with HbA1c<6.5%[0(0~3.4)points/year vs 0.3(0~3.0)points/year vs 1.0(0~5.1)points/year,P=0.049.0(-0.4~2.7)points/year vs 0.6(0~4.0)points/year vs 0.9(0~4.2)points/year,P=0.029]in T2DM patients.【Conclusion】Except for achievement of LDL-C goals,there might become differences in risk factors for progression of coronary lesions between T2DM and NDM patients.Smoking,Lp(a),TC,HDL-C and control levels of HbA1c are independent predictors in T2DM as well as BMI and ApoA in NDM.Lowering HbA1c to less than 6.5%may delay progression of lesion.

关 键 词：2型糖尿病 冠状动脉粥样硬化 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]