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目的分析急性冠脉综合征(ACS)合并糖代谢异常患者的冠脉病变特征。方法155例急性ACS患者分为糖耐量正常(A)组、合并糖耐量异常(B)组、合并糖尿病(C)组,所有病例均行75 g葡萄糖耐量试验,测定血糖(FBG、PBG)、胰岛素(FINS、PINS)、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血脂等指标,95例作了冠状动脉造影。比较3组患者的血糖、胰岛素、糖化血红蛋白、高敏C反应蛋白、血脂及冠脉病变。结果C组、B组与A组的FBG、PBG、FINS、PINS、HbA1c、Hs-CRP、TC、LDL-C、UMALB等生化指标比较,差异有统计学意义(P<0.01或0.05);C组和B组的PINS、TC水平差异无统计学意义(P>0.05);B和C组的冠状动脉造影显示病变更为严重,多支血管病变的发生率明显高于A组,差异均有统计学意义(P<0.01);多支血管病变的发生率在B组和C组间的差异无统计学意义(P>0.05)。结论与糖代谢正常的ACS患者相比,合并糖代谢异常的ACS患者有更高的胰岛素水平和高敏C反应蛋白水平,冠脉病变更为严重。糖耐量异常与患糖尿病的ACS患者的冠脉病变相似。
Objective To analyze the characteristics of coronary lesions in patients with acute coronary syndrome (ACS) complicated with abnormal glucose metabolism. Methods A total of 155 patients with acute ACS were divided into three groups: normal glucose tolerance group (A), combined glucose tolerance group (B) and diabetes mellitus group (C). All patients underwent 75 g glucose tolerance test and blood glucose (FBG, Insulin (FINS, PINS), HbA1c, hs-CRP, blood lipids and other indicators, 95 patients underwent coronary angiography. Blood glucose, insulin, glycosylated hemoglobin, high-sensitivity C-reactive protein, lipids and coronary lesions were compared between the three groups. Results The biochemical indexes of FBG, PBG, FINS, PINS, HbA1c, Hs-CRP, TC, LDL-C and UMALB in group C, group B and group A were significantly different (P <0.01 or 0.05) There was no significant difference in the levels of PINS and TC between group B and group C (P> 0.05). Coronary angiography in groups B and C showed more severe lesions and multivessel lesions were significantly higher than those in group A Statistical significance (P <0.01). The incidence of multivessel disease in group B and group C was no significant difference (P> 0.05). Conclusions ACS patients with abnormal glucose metabolism have higher insulin levels and high-sensitivity C-reactive protein levels than ACS patients with normal glucose metabolism and coronary artery disease is more severe. Impaired glucose tolerance is similar to coronary lesions in ACS patients with diabetes.