糖化血红蛋白水平对急性心肌梗死合并糖尿病患者冠状动脉病变程度的影响  

Correlation between Glycosylated Hemoglobin Alc Level and the Severity of Coronary Artery Disease in Patients with Acute Myocardial Infarction and Diabetes Mellitus

作　　者：曹树军 许振业 汤玮 董宁超 程国杰 CAO Shujun;XU Zhenye;TANG Wei;Dong Ningchao;CHENG Guojie(Department of Cardiology,Capital Medical University Daxing Teaching Hospital,Beijing 102600,China)

机构地区：[1]首都医科大学大兴教学医院心内科,北京102600

出　　处：《中国分子心脏病学杂志》2024年第4期6220-6225,共6页Molecular Cardiology of China

摘　　要：目的 探讨糖化血红蛋白水平对急性心肌梗死(AMI)合并糖尿病(DM)患者冠状动脉病变程度的影响。方法 选择2020年1月至12月在首都医科大学大兴教学医院住院的213例AMI合并DM患者作为研究对象,所有患者均行冠状动脉造影,并应用SYNTAX积分进行评估。根据SYNTAX积分将冠状动脉病变严重程度分为轻度(SYNTAX积分0~22分)、中度(SYNTAX积分23~32分)、重度(SYNTAX积分>32分),同时测定入组患者的HbA1c水平。采用有序logistic回归分析HbA1c水平对冠状动脉病变程度的影响。结果 冠状动脉病变轻、中、重度患者糖化血红蛋白水平逐渐升高,且轻度病变组(6.9%±1.1%)、中度病变组(8.7%±1.4%)和重度病变组(10.1%±1.6%)两两比较差异均具有统计学意义(P均<0.05)。对急性ST段抬高心肌梗死患者和急性非ST段抬高心肌梗死患者进行亚组分析发现,冠状动脉轻度病变组与重度病变组的糖化血红蛋白水平差异仍有统计学意义(P<0.05)。Pearson相关性分析表明,糖化血红蛋白水平与SYNTAX积分存在正相关性(r=0.212,P<0.001)。有序logistic回归分析提示,糖化血红蛋白是AMI合并DM患者严重冠状动脉病变的独立影响因素(OR=3.630,95%CI:1.785~7.378,P<0.05)。结论 糖化血红蛋白水平与AMI合并DM患者冠状动脉病变严重程度密切相关,是严重冠状动脉病变的独立影响因素,有效的血糖管理可能会减轻冠状动脉病变的严重性。Objective To investigate the effect of glycosylated hemoglobin Alc(HbA1c) level on the severity of coronary artery disease in patients with acute myocardial infarction(AMI) and diabetes(DM).Methods A study was conducted on 213 patients with AMI and DM who were admitted to Capital Medical University Daxing Teaching Hospital from January to December 2020.All patients underwent coronary angiography,and the severity of coronary lesions was evaluated using the SYNTAX score and divided into three groups:SYNTAX score 0-22 for mild lesions,SYNTAX score 23-32 for moderate lesions,and SYNTAX score greater than 32 for severe lesions.The HbA1c levels of enrolled patients were also measured.Logistic regression analysis was used to investigate the correlation between HbA1c levels and the severity of coronary artery disease.Results The average HbAlc level gradually increased in the three groups of patients,and there was a statistically significant difference(P<0.05) between the mild lesion group(6.9%±1.1%),the moderate lesion group(8.7%±1.4%),and the severe lesion group(10.1%±1.6%).In the subgroup analysis of acute ST segment elevation myocardial infarction group and non ST segment elevation myocardial infarction group,it was found that there was a statistically significant difference in HbAlc levels between mild and severe lesions(P<0.05).Simple linear regression analysis showed a correlation between HbA1c levels and SYNTAX scores(r=0.212,P<0.001).Further logistic regression analysis showed that HbA1c levels were an independent influencing factor for severe coronary artery disease in patients with AMI and DM(OR=3.630,95%CI:1.785-7.378,P<0.05).Conclusion HbAlc level is closely related to the severity of coronary artery disease and is an independent influencing factor for severe coronary artery disease in patients with AMI and DM.Effective blood glucose management may reduce the severity of coronary artery disease.

关 键 词：急性心肌梗死 糖尿病 糖化血红蛋白 冠状动脉病变程度 有序logistic回归 

分 类 号：R542.22[医药卫生—心血管疾病] R587.2[医药卫生—内科学]