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目的探讨糖化血红蛋白(HbA1c)、同型半胱氨酸(hypohomocysteinemia,Hcy)与冠心病(coronary heart dis-ease,CHD)的关系,评价HbA1c联合Hcy检测在CHD中的临床意义。方法收集湛江中心人民医院2009年1月-2010年6月通过冠脉造影确诊为冠心病患者125例为研究对象,根据空腹血糖和HbA1c结果分为单纯冠心病组、冠心病合并糖尿病组之血糖控制良好组及血糖控制不良组;并选择同期健康体检者86例为健康对照组。用免疫透射比浊法测定HbA1c、酶法测定Hcy,比较各组的HbA1c、Hcy、Gensini积分以及三者的相关性。结果比较三组间的HbA1c,冠心病合并糖尿病组与单纯冠心病组及健康对照组比较,差异均具有统计学意义(P<0.05),单纯冠心病组与健康对照组比较差异无统计学意义(P>0.05);而三组间的Hcy两两比较,差异均具有统计学意义(P<0.05);单纯冠心病组、冠心病合并糖尿病组之血糖控制良好组及血糖控制不良组的HbA1c、Hcy、Gensini积分的相关性良好(分别为r=0.79,P<0.05;r=0.89,P<0.05;r=0.97,P<0.05)。结论高HbA1c、Hcy血症与冠心病密切相关,因此对冠心病患者联合检测HbA1c、Hcy,一方面可以快速、准确监测冠心病患者的血糖控制水平,另一方面可以初步评估冠心病病变严重程度,及时制定适当的诊疗措施,从而延缓、降低冠状动脉发生粥样硬化的风险,减少冠心病的发生率及病死率。
Objective To investigate the relationship between HbA1c, homocysteinemia (Hcy) and coronary heart disease (CHD) and to evaluate the clinical significance of HbA1c combined with Hcy test in CHD. Methods From January 2009 to June 2010, 125 cases diagnosed as coronary heart disease by coronary angiography were collected from Zhanjiang Central People’s Hospital. According to the results of fasting blood glucose and HbA1c, the patients were divided into simple coronary heart disease group, coronary heart disease complicated with diabetes group, Control well group and poor glycemic control group; and select the same period, 86 healthy subjects were healthy control group. HbA1c was determined by immunoturbidimetry and Hcy by enzymatic method. The HbA1c, Hcy, Gensini scores and the correlation among the three groups were compared. Results Compared HbA1c, coronary heart disease with diabetes mellitus group and simple coronary heart disease group and healthy control group, the differences were statistically significant (P <0.05), there was no significant difference between simple coronary heart disease group and healthy control group (P> 0.05). The Hcy between the three groups was statistically significant (P <0.05). The HbA1c levels in the patients with simple coronary heart disease, coronary heart disease with diabetes mellitus and those with poor glycemic control , Hcy and Gensini scores (r = 0.79, P <0.05; r = 0.89, P <0.05; r = 0.97, P <0.05 respectively). Conclusions High HbA1c and Hcy are closely related to coronary heart disease. Therefore, the combined detection of HbA1c and Hcy in patients with coronary heart disease can rapidly and accurately monitor the blood sugar level of patients with coronary heart disease. On the other hand, the severity of coronary heart disease can be preliminarily evaluated , Timely development of appropriate diagnosis and treatment measures, thus delaying and reducing coronary atherosclerosis risk and reduce the incidence of coronary heart disease and mortality.