新疆地区哈萨克族无糖尿病人群空腹血糖与冠状动脉病变严重程度的关系

摘要

Objective To investigate the relationship between the fasting blood glucose level and the severity of coronary artery disease among the Kazakh population in Xinjiang. Methods A total of 411 Kazakh patients with no known history of diabetes mellitus were enrolled in this study for highly suspected of coronary artery disease(CAD) and subesquently underwent coronary artery angiography. Coronary artery disease was diagnosed in 280 patients after coronary artery argiography. The severity of the disease was expressed in terms of Gensini score. All subjects were classified into 4 groups according to the level of fasting plasma glucose (FPG)< 5.6 mmol / L, 5.6-6.1 mmol / L, 6.1-7.0 mmol / L and ≥7.0 mmol / L. All the biochemical parameters, clinical data and coronary artery angiographic data were compared, and the possible risk factors related to the severity of coronary artery disease were studied. Results Multivariate logistic regression analysis showed that FPG was significantly associated with coronary artery disease(OR 1.53, 95% CI 1.25-1.87,P<0.001).The results showed that the prevalence of angiographic CAD and the Gensini score increased with the increasing FPG levels among the four groups.The FPG level was significantly correlated with the Gensini score (P<0.001). Conclusions FPG is significantly associated with coronary artery disease and its severity in the Kazakh population in Xinjiang.%目的 探讨新疆地区哈萨克族无糖尿病人群空腹血糖(FPG)水平与冠状动脉病变严重程度的关系.方法 纳入哈萨克族因高度疑诊冠心病行冠状动脉造影且既往无糖尿病的患者411例,根据冠状动脉造影将所有患者分为冠心病组(280例)和非冠心病组(131例).冠状动脉病变严重程度以 Gensini 评分表示.根据FPG水平将所有研究对象分为 4 组[组 1(FPG<5.6 mmol/L)、组2(5.6 mmol/L≤FPG<6.1 mmol/L)、组 3(6.1 mmol/L≤FPG<7.0 mmol/L)、组 4(FPG≥7.0 mmol/L)].对患者生化指标、一般临床资料、冠状动脉造影资料进行比较,探讨与冠状动脉病变严重程度相关的危险因素.结果 非冠心病组患者年龄[(55.05±10.32)岁比(59.00±10.11)岁, P<0.001]、男性(67.2%比77.1%,P=0.032)、吸烟史(38.2%比59.3%,P<0.001)、体重指数(BMI) [(22.96±1.62)kg/m2比(23.37±1.50)kg/m2,P=0.012]、高血压病(45.8%比62.1%,P=0.002)、FPG [(5.11±1.17)mmol/L比(6.34±2.51)mmol/L,P<0.001]、总胆固醇(TC) [(4.14±0.82)mmol/L比(3.95±0.96)mmol/L,P=0.040]、Gensini评分[(0.27±0.69)分比(36.63±33.88)分,P<0.001]均低于冠心病组,差异均有统计学意义;非冠心病组高密度脂蛋白胆固醇(HDL-C)[(1.13±0.28)mmol/L比(1.06±0.31)mmol/L,P=0.038]高于冠心病组,差异有统计学意义.组1、组2、组3及组4四组患者糖化血红蛋白(HbA1c) [(2.17±0.33)mmol/L比(2.16±0.27)mmol/L比(2.30±0.28)mmol/L比(2.51±0.59)mmol/L,P<0.001]、三酰甘油(TG)[(1.67±1.60)mmol/L比(1.85±1.21)mmol/L比(2.08±1.34)mmol/L比(2.23±1.51)mmol/L,P=0.026]、低密度脂蛋白胆固醇(LDL-C) [(2.59±0.80)mmol/L比(2.71±0.81)mmol/L比(2.66±0.86)mmol/L比(2.35±0.74)mmol/L, P=0.040]和 HDL-C[(1.13±0.30)mmol/L比(1.00±0.31)mmol/L比(1.07±0.29)mmol/L比(0.99±0.29)mmol/L,P<0.001]比较,差异均有统计学意义.患者FPG与Gensini评分Pearson相关性分析显示,两者明显相关(r=0.236,P<0.001),Gensini评分随着FPG浓度的增加而逐渐增加;多因素logistic回归分析发现,FPG(OR 1.53,95%CI 1.25~1.87,P<0.001)、年龄(OR 1.05, 95%CI 1.02~1.08,P<0.001)、BMI(OR 1.20,95% CI 1.03~1.39,P=0.020)、吸烟史(OR 2.87, 95%CI 1.61~5.10,P<0.001)及高血压病(OR 1.64,95%CI 1.02~2.64,P=0.041)均是冠心病相关的危险因素; 多元线性回归分析显示,冠状动脉病变严重程度(Gensini评分)与FPG、年龄及吸烟呈正相关,与 HDL-C浓度呈负相关.结论 新疆地区哈萨克族无糖尿病人群的 FPG 与冠心病发生以及冠状动脉病变严重程度相关.