冠心病患者行OGTT试验及糖化血红蛋白检测的必要性研究

The necessity of checking OGTT test and HbA1c for patients with coronary heart disease

关键词:  冠心病  糖耐量异常  口服葡萄糖耐量试验  糖化血红蛋白

Key words:  coronary heart disease  impaired glucose tolerance  oral glucose tolerance test  glycosylated hemoglobin

摘要:

目的探讨冠心病患者入院后行口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）及检测糖化血红蛋白（HbAlc）的必要性。方法收集10个月因怀疑冠心病而住院的心内科患者116例，住院期间行OGTT试验及冠脉造影并检测HbAlc，比较各组Gensini积分、糖化血红蛋白水平以及二者相关性。结果OGTT试验发现84例（72．4％）糖代谢异常患者，但空腹血糖检查仪发现10例（9％）。比较三纽之间的HbAlc及冠心病痛变程度（Gensini积分），冠心病合并糖耐量异常组及冠心病合并糖尿病组分别同单纯冠心病组比较均具差异有统计学意义（P〈0．01），冠心病合并糖耐量异常组及冠心病合并糖尿病组比较差异有统计学意义（P〈0．05）；而三组间的HbAlc与冠心病病变程度相关性良好（R=0．76，P〈0．01）。结论对怀疑冠心病住院患者，单纯空腹血糖监测会漏诊大量糖代谢异常患者，冠心病住院患者多合并血糖代谢异常，入院常规的OGTT试验可帮助筛查和明确。HbAlc是冠心病的独立危险因素，入院后常规监测可帮助评估血糖控制情况及预后。

Abstract:

Objective To study the necessity of checking OGTT test and HbAlc for patient with coronary heart disease（CHD）. Methods One hundred and sixteen cases of suspected coronary heart disease were collected during their hospitalization in 10 months. OGTT test and levels of HbAlc for all patients during their hospitalization were checked and the difference in three groups and the correlation between Gensini score and HbAlc were analyzed. Results The OGTT test found that 84 cases were of abnormal glucose metabolism, but the number was only 10 cases through checking fasting blood- glucose. Both the levels of HbA1 c and coronary artery narrow degree （Gensini score） accompanied with T2DM group and IGT group were significantly higher than those of the simple CHD group （P 〈 0.01 ）. Both levels in T2DM group compared with that in IGT group had difference too （ P 〈 0.05 ）.Correlation analysis showed the level of HbAlc was positively correlated with Gensini score in CHD patients（R = 0.76, P 〈 0.01 ）. Conclusion Fasting blood glucose will miss a lot of suspected CHD patients with abnormal glucose metabolism. The CHD patients always have abnormal glucose metabolism. OGTT test can help to screen and confirm diagnosis. The higher level of HbAlc was an independent dangerous factor for CHD. Routine check after admission can help to evaluate the control of blood glucose and the outcome of patients with CHD.