2型糖尿病患者血清糖化白蛋白水平与冠脉侧支循环的关系研究

摘要

目的：探讨2型糖尿病患者血清糖化白蛋白水平与冠脉侧支循环的关系，并与非糖尿病患者作比较。方法：入选连续434例稳定型心绞痛伴1支或以上冠脉完全阻塞的患者，其中糖尿病组317例，非糖尿病组117例。检测空腹血清糖化白蛋白（GA）和糖化血红蛋白（HbA1c）水平，并用 Rentrop 计分法评估阻塞远端来自对侧冠脉提供的侧支循环情况（Rentrop 0或1分为侧支循环不佳，2或3分为侧支循环良好）。结果：在总的437例患者中，侧支循环不佳患者的 GA[（20．9±6．3）％对（18．6±5．5）％， P ＜0．001]和 HbA1c[（6．9±1．0）％对（6．7±1．1）％，P ＜0．05]显著高于侧支循环良好患者。糖尿病组中，侧支循环不佳患者（118例）较侧支循环良好者（199例）血清 GA 水平明显增高，为（21．2±6．5）％对（18．7±5．6）％，P ＜0．001；但 HbA1c 水平相似，为（7．0±1．1）％对（6．8±1．3）％，P ＝0．27。GA 与 Rentrop 计分呈显著负相关（r＝-0．28， P ＜0．001），但 HbA1c 与其无关（r＝-0．10，P ＝0．09）。在预测冠脉侧支循环不佳方面，GA 的曲线下面积较 HbA1c 明显增大（0．64对0．58）。在非糖尿病组，GA 和 HbA1c水平与冠脉侧支循环状态无关。多因素分析发现，年龄＞65岁、女性、非高血压、高脂血症和肾功能减退是预测糖尿病和非糖尿病患者冠脉侧支循环不佳的独立危险因素。经校正混杂因素后，GA＞18．3％仍然较 HbA1c＞7％更为敏感地预测糖尿病患者冠脉侧支循环不佳。结论：血清 GA 水平增高是2型糖尿病患者冠脉侧支循环形成不佳的重要原因之一。%Objective:This study aimed to evaluate the relationship between serum glycated albumin (GA)level and coronary collateral circulation in type 2 diabetic patients,and compare with that in non-diabetics. Methods:434 patients with stable angina and angiographic total occlusion of at least one major coronary artery were included. Serum GA levels and blood concentration of glycated hemoglobin (HbA1c)were determined,and the degree of coronary collateralization was assessed by the Rentrop scoring system and defined as poor (Rentrop score 0/1)or good (Rentrop score 2/3)collateral growth. Resuits:In overall patients,GA [(20.9 ± 6.3)% vs.(18.6 ± 5.5 )%,P <0.001 ]and HbA1c levels [(6.9±1 .0)% vs.(6.7±1 .1 )%,P <0.05]were significantly higher in poor than in good collaterals.In 317 diabetic patients,GA levels were consistently elevated in 199 patients with poor than in other 118 patients with good collaterals [(21 .2±6.5)% vs.(18.7±5.6)%,P <0.001],but blood concentration of HbA1c was similar [(7.0±1 .1)% vs.(6.8±1 .3)%,P =0.27].GA but not HbA1c levels correlated inversely with the Rentrop’s grades (r= -0.28,P <0.001 andr= -0.10, P =0.09),and the area under the curve of GA was larger than that of HbA1c for predicting the presence of poor collaterals.In contrast,there was no relation between the serum levels of GA and HbA1c and the degree of coronary collaterals in non-diabetic patients.Multivariable analysis showed that older age, female gender,non-hypertension,dyslipidemia and renal impairment were independently associated with low collateralization in diabetic and non-diabetic patients.After adjusting for confounding factors,GA<18.3% remained an independent factor for predicting the presence of poor collaterals in diabetic patients. Conciusion:Increased serum GA level is an important cause of impaired coronary collateral growth in type 2 diabetic patients with stable angina and chronic total occlusion.