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目的 探讨老年冠心病合并糖尿病患者冠状动脉病变特点及其相关危险因素。 方法 根据 1997年WHO糖尿病诊断标准 ,对 133例冠心病 (CHD)患者行口服 75g葡萄糖耐量试验 ,其中冠心病合并糖尿病 (CHD +DM)组 6 5例 ,单纯CHD组 6 8例 ,133例患者均行冠状动脉造影 (CAG) ,检测血糖、胰岛素、血脂、血压、血尿素氮 (BUN)、血肌酐 (Cr)。冠状动脉病变程度应用CAG分析 ,冠状动脉狭窄程度根据美国心脏协会 (AHA) 1975年分类标准评价 ,冠状动脉病变的危险因素应用多元逐步直线回归分析。 结果 CHD +DM组多支冠状动脉病变的发生率高于CHD组 (75 4 %与 38 2 % ,P<0 0 5 ) ;冠状动脉狭窄 (8 6± 3 8与 6 5± 3 9,P <0 0 5 )及钙化程度 (6 6± 6 1与 3 9± 4 1,P <0 0 5 )高于CHD组 ;冠状动脉远端病变发生率高于CHD组 (41 2 %与 13 1% ,P <0 0 5 ) ;血脂、胰岛素、血压与冠状动脉粥样硬化程度明显正相关 (P <0 0 0 1)。 结论 老年CHD +DM患者多支冠状动脉病变的发生率增高 ,病变多呈弥漫性狭窄 ,远端血管病变发生率高。提示糖尿病、高脂血症、高血压是发生冠状动脉粥样硬化的独立危险因素
Objective To investigate the characteristics of coronary lesions and its related risk factors in elderly patients with coronary heart disease complicated with diabetes mellitus. Methods According to the diagnostic criteria of WHO in 1997, 133 patients with coronary heart disease (CHD) were given 75g oral glucose tolerance test, including 65 CHD + DM patients, 68 CHD patients and 133 patients Coronary angiography (CAG) was performed to detect blood glucose, insulin, blood lipid, blood pressure, blood urea nitrogen (BUN) and serum creatinine (Cr). The degree of coronary artery disease was analyzed by CAG. The degree of coronary artery stenosis was evaluated according to the American Heart Association (AHA) classification criteria in 1975. The risk factors of coronary artery disease were analyzed by multivariate stepwise linear regression analysis. Results The incidence of multivessel coronary artery disease in CHD + DM group was significantly higher than that in CHD group (75.4% versus 38.2%, P <0.05), coronary artery stenosis (86.38 vs 65.39%, P (P0.05), the degree of calcification (66 ± 6 1 vs 39 ± 41, P <0 05) was higher than that of CHD group. The incidence of distal coronary artery disease was higher than that of CHD group (41.2% vs 13 1 %, P <0.05). The levels of serum lipids, insulin and blood pressure were positively correlated with the degree of coronary atherosclerosis (P <0.01). Conclusion The incidence of multivessel coronary artery disease in elderly patients with CHD + DM is increased. Most of the patients have diffuse stenosis and the incidence of distal vascular lesions is high. Tip diabetes, hyperlipidemia, hypertension is an independent risk factor for coronary atherosclerosis