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目的分析冠心病合并代谢综合征患者的临床特征和冠状动脉病变特点。方法回顾性分析本院175例冠心病患者的临床资料及冠状动脉造影结果,按照ATPⅢ诊断标准分为代谢综合征组和无代谢综合征组,以冠状动脉病变积分评价其病变程度。结果175例中89例(50.9%)合并代谢综合征。代谢综合征组的体重指数、腰围、总胆固醇、甘油三酯、尿酸、空腹血糖、餐后2h血糖、糖化血红蛋白、稳态模型的胰岛素抵抗指数及心肌梗死的发生率均显著高于无代谢综合征组,而高密度脂蛋白胆固醇水平显著低于后者;其冠状动脉多支病变发生率(65.1%比45.4%,P<0.01)及冠状动脉病变总积分均显著高于无代谢综合征组(7.5±3.6比6.4±3.3,P<0.05);代谢综合征组中合并糖尿病患者的冠状动脉病变总积分也高于无糖尿病患者(8.0±3.7比6.3±3.5,P<0.05)。相关分析显示,冠状动脉病变程度与患者的腰围、总胆固醇、甘油三酯、糖化血红蛋白、空腹血糖及餐后2h血糖水平呈明显正相关(P<0.05),与高密度脂蛋白胆固醇呈负相关(P<0.01)。结论冠心病患者中合并代谢综合征较为普遍,且合并代谢综合征患者的冠状动脉病变呈多支性、狭窄程度更高,应进行全面心血管危险因素防治,以改善预后。
Objective To analyze the clinical features and the characteristics of coronary lesions in patients with coronary heart disease and metabolic syndrome. Methods The clinical data and coronary angiography results of 175 patients with coronary heart disease in our hospital were retrospectively analyzed. According to the diagnostic criteria of ATP Ⅲ, the patients were divided into metabolic syndrome group and non-metabolic syndrome group, and the severity of coronary artery disease was evaluated by coronary artery disease. Results In 175 cases, 89 patients (50.9%) had metabolic syndrome. Body mass index, waist circumference, total cholesterol, triglycerides, uric acid, fasting blood glucose, postprandial 2h blood glucose, glycosylated hemoglobin, insulin resistance index and myocardial infarction in patients with metabolic syndrome were significantly higher than those without metabolic syndrome (65.1% vs 45.4%, P <0.01) and the total score of coronary artery disease were significantly higher than those without metabolic syndrome (7.5 ± 3.6 vs 6.4 ± 3.3, P <0.05). The total score of coronary lesions in patients with metabolic syndrome was also higher than those without diabetes (8.0 ± 3.7 vs. 6.3 ± 3.5, P <0.05). Correlation analysis showed that the degree of coronary artery disease was positively correlated with waist circumference, total cholesterol, triglyceride, HbA1c, fasting blood glucose and postprandial 2h blood glucose level (P <0.05), but negatively correlated with high density lipoprotein cholesterol (P <0.01). Conclusion Metabolic syndrome is common in patients with coronary heart disease. In patients with metabolic syndrome, coronary lesions are multi-branched and have a high degree of stenosis. Comprehensive cardiovascular risk factors should be controlled to improve the prognosis.