摘要
背景冠状动脉微血管疾病(CMVD)是一种特殊的非阻塞性冠状动脉疾病,患者主要不良心血管事件发生率较高且预后差,目前CMVD的发病机制及其危险因素尚未完全明确。目的探讨糖化血红蛋白(HbA1c)与冠状动脉微血管心绞痛(CMVA)的关系。方法选取2018年1月—2019年9月徐州医科大学第二附属医院收治的CMVA患者57例作为CMVA组,另选取2型糖尿病患者50例作为糖尿病组,本院同期健康体检者32例为健康对照组。观察三组受试者99锝m-甲氧基异丁基异腈(99Tcm-MIBI)门控心肌灌注显像(G-MPI)图像,并比较三组受试者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、超敏C反应蛋白(hs-CRP)及HbA1c。采用多因素Logistic回归分析探讨CMVA的影响因素,并绘制受试者工作特征(ROC)曲线以评价hs-CRP、HbA1c对CMVA的预测价值。结果CMVA组患者99Tcm-MIBI G-MPI静息像及负荷像均见心肌放射性分布异常,存在不同程度心肌缺血;糖尿病组及健康对照组患者99Tcm-MIBI G-MPI静息像及负荷像均未见明显心肌缺血改变。三组患者TC、TG、LDL-C、HDL-C、FBG比较,差异无统计学意义(P>0.05);CMVA组、糖尿病组患者hs-CRP、HbA1c高于健康对照组,CMVA组患者hs-CRP、HbA1c高于糖尿病组(P<0.05)。多因素Logistic回归分析结果显示,hs-CRP〔OR=24.189,95%CI(7.153,81.798)〕、HbA1c〔OR=7.596,95%CI(2.712,21.278)〕是CMVA的独立危险因素(P<0.05)。ROC曲线显示,hs-CRP、HbA1c预测CMVA的ROC曲线下面积(AUC)分别为0.848〔95%CI(0.785,0.911)〕、0.830〔95%CI(0.757,0.903)〕。结论CMVA患者多存在不同程度心肌缺血,而HbA1c是CMVA的独立危险因素,且其对CMVA具有较高的预测价值。
Background Coronary microvascular disease(CMVD)is a special non-obstructive coronary disease and the patients have a high incidence of major adverse cardiovascular diseases and poor prognosis.At present,the pathogenesis of CMVD and its risk factors have not been fully identified.Objective To explore the relationship between glycosylated hemoglobin(HbA1c)and coronary microvascular angina(CMVA).Methods From January 2018 to September 2019,57 patients with CMVA who admitted to the Second Affiliated Hospital of Xuzhou Medical University were selected as the CMVA group,and 50 patients with type 2 diabetes were selected as the diabetic group,and 32 healthy people in our hospital during the same period were selected as the healthy control group.99Tcm-methoxy isobutyl isonitrile(99Tcm-MIBI)gated myocardial perfusion imaging(G-MPI)were observed in the three groups,and the total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),fasting blood glucose(FBG),hypersensitive C-reactive protein(hs-CRP)and HbA1c were compared in three groups.Multivariate Logistic regression analysis was used to analyze the influencing factors of CMVA,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of hs-CRP and HbA1c on CMVA.Results The rest and load images of 99Tcm-MIBI G-MPI in patients of CMVA group showed abnormal distribution of myocardial radioactivity,and there were different degrees of myocardial ischemia.But the rest and load images of 99Tcm-MIBI G-MPI in patients of diabetic group and healthy control group showed no obvious changes of myocardial ischemia.There was no significant difference in TC,TG,LDL-C,HDL-C or FBG in the three groups(P>0.05);levels of hs-CRP and HbA1c in CMVA group and diabetes group were higher than those in healthy control group,and those in CMVA group were higher than those in diabetes group(P<0.05).Multivariate Logistic regression analysis showed that,hs-CRP〔OR=24.189,95%CI(7.153,81.798)〕,HbA1c�
作者
陈雪瑾
祁春梅
金静静
CHEN Xuejin;QI Chunmei;JIN Jingjing(Xuzhou Medical University,Xuzhou 221000,China;Department of Cardiovascular Medicine,the Second Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)
出处
《实用心脑肺血管病杂志》
2020年第6期28-35,共8页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
