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疑似冠心病患者口服葡萄糖耐量试验和血清胰岛素水平检测的临床意义(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第4期
页码:
467-471
栏目:
临床研究
出版日期:
2008-08-20

文章信息/Info

Title:
Oral glucose tolerance tests and serum insulin levels in patients suspected to coronary artery disease and its clinical significance
作者:
郑莺; 刘建平; 何奔
上海交通大学医学院附属仁济医院心内科，上海 200127
Author(s):
ZHENG Ying;  LIU Jianping;  HE Ben
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
关键词:
口服葡萄糖耐量试验; 糖代谢状态; 高胰岛素血症; 冠状动脉疾病
Keywords:
oral glucose tolerance test;  glucometabolic state;  hyperinsulinemia;  coronary disease
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 观察无糖尿病病史的首次冠状动脉造影（CAG）人群的糖代谢状况，于不同糖代谢状态下分别比较组间血清胰岛素水平的差异，并探讨其临床意义。 方法 研究对象共184例，按照美国糖尿病协会(ADA)2003年标准调查其糖代谢状态；分析冠心病组和对照组之间以及0支、单支、多支病变组间血清胰岛素水平及其它指标的差异。 结果 首次CAG患者中糖代谢异常非常普遍，使用口服葡萄糖耐量试验（OGTT）可发现其中636%的患者存在糖代谢异常。对正常糖耐量的患者分析表明，冠心病组2 h胰岛素(2hINS)水平明显高于对照组，而空腹胰岛素(FINS)在两组间无明显差异；且2hINS还与病变严重程度相关；Logistic回归表明在多因素存在的条件下，2hINS仍然与冠心病发病相关。对糖调节受损的患者进行分析也有相似的结果。而糖尿病患者中未发现冠心病组和对照组之间血清胰岛素水平的差异。 结论 疑似冠心病患者应积极推荐OGTT(二点法)，并加测血清胰岛素水平，不但有助于及早发现糖代谢异常，还有助于冠心病的筛查。
Abstract:
AIM To investigate the glucometabolic state of patients undergoing their first coronary angiography (CAG) without known diabetes mellitus (DM) and the serum insulin levels in different glucometabolic state, and to explore their clinical significance. METHODS One hundred and eightfour enrolled patients were divided into the coronary artery disease (CAD) group and control group on the basis of CAG or divided into 0vessle disease group (normal), singlevessel disease group and multivessel disease group according to the number of involved vessels. The difference of serum insulin levels and other factors in different groups was evaluated. RESULTS Impaired glucose metabolism was very common in patients undergoing their first CAG and newly detected impaired glucose metabolism was found in 63.6% of all the patients by 75 g oral glucose tolerance test (OGTT). With normal glucose tolerance (NGT), the 2 h postchallenge serum insulin (2hINS) level was significantly higher in CHD group compared with that in control group and it was associated with the severity of coronary artery lesion. No significant difference in fasting insulin (FINS) level was observed between the CAD and control groups. The multiple logistic regression analysis showed that independent determinant of the presence of CAD was 2hINS in patients with NGT or impaired glucose regulation (IGR). There was no significant difference of serum INS levels between CAD group and control group in the patients with confirmed diabetes mellitus. CONCLUSION OGTT should be routinely used to assess the glucometabolic state of patients suspected to CAD and detection of FINS and 2hINS would be helpful for the screening of CAD.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2008-03-27.通讯作者：刘建平，教授，主要从事冠心病诊治研究Email:jpl@medmail.com.cn 作者简介：郑莺，住院医师，硕士Email:drzhengying@yahoo.com.cn
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