目的 现察Ⅱ型糖尿病(T2DM)合并冠心病患者的临床特征和冠状动脉造影特点.方法 对293例经冠状动脉造影确诊的冠心痛患者,均进行口服75 g葡萄糖耐量试验,根据1999年WHO标准分为Ⅱ型糖尿病合并冠心病组149例,单纯冠心痛组144例.检测血糖、胰岛素、HbA1C,血脂、尿白蛋白,肌酐比值,采用稳态模型计算胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-Is).对比分析两组患者的临床和冠状动脉造影资料.结果 与单纯冠心痛组比较,Ⅱ型糖尿病合并冠心痛组胰岛素抵抗指数和尿白蛋白,肌酐比值明显增高(均P＜0.05),胰岛素分泌指数明显降低(P＜0.01).Ⅱ型糖尿病合并冠心病组发生3支病变较多(P＜0.05),冠状动脉重度狭窄、完全闭塞、弥漫病变比例较高(P＜0.05).结论 Ⅱ型糖尿病合并冠心痛组冠状动脉病变累及范围广且程度重.%Objective To investigate the clinical features and coronary angiography characters of patients with type 2 diabetes and coronary heart disease(CHD). Methods Oral glucose(75g) tolerance tests were carried out among 293 patients with definite diagnosis of CHD by coronary angiography. According to the diabetes diagnosis criterion of WHO (1999), all the patients were divided into two groups which including 149 individuals of CHD accompanied by type 2 diabetes with average age of 66. L±8.0(male of 102 . Female of 47), and 144 individuals of isolated CHD with average age of 64. 5±8. 5(male of 111. Female of 33). Plasma glucose and insulin. HbAlc, serum lipid, urine albumin to creatinine ratio (ACR) were measured. The insulin resistant index and insulin secretion index were calculated by homeostasis model. Then we analyzed and compared the clinical and coronary angiography data of these two groups. Results The insulin resistant index and ACR of CHD accompanied by type 2 diabetes group were significantly higher than isolated CHD indi-viduals(P<0. 05), but insulin secretion index decreased markedly(P<0. 01). Three branches coronary pathological changes were more easily developed in CHD accompanied by type 2 diabetes group(P<0. 05), the ratios of severe coronary artery stenosis, complete occlusion and diffuse lesion were also more higher in this group(P<0. 05). Conclusion Pathological changes of coronary in CHD accompanied by type 2 diabetes group are severe and involved wide range.
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