CAJ | 학술논문

目的：检测冠心病稳定型心绞痛合并2型糖尿病老年患者冠状动脉介入术前的血糖及糖基化产物水平，了解其与介入治疗短期预后的关系。方法连续选取2010年1月至2012年12月于海军总医院住院接受冠状动脉介入治疗的稳定型心绞痛合并2型糖尿病老年患者188例，根据是否出现缺血并发症如复发心绞痛、心肌梗死及死亡，将患者分为事件组和对照组；观察两组心血管病术前临床危险因素、血糖、糖基化产物（糖化血红蛋白和糖化血清蛋白）及高敏C反应蛋白水平的差异，评价各组术前危险因素、糖代谢及炎症反应指标的差异。结果事件组与对照组相比较，年龄、性别、体质量指数、吸烟史、高血压及高脂血症发病率、用药情况以及糖化血红蛋白水平差异均无统计学意义（P＞0.05）；空腹血糖、糖化血清蛋白以及高敏C反应蛋白水平明显增高（P＜0.01）；以220μmol/L为界值，糖化血清蛋白升高患者出现围术期缺血并发症的风险明显增加（OR＝2.96，95%CI：1.50～5.81，P＝0.001）。结论糖基化产物中，术前糖化血清蛋白水平增高可能是糖尿病合并稳定型心绞痛老年患者冠状动脉介入治疗围术期缺血并发症的危险预测指标。
목적：검측관심병은정형심교통합병2형당뇨병노년환자관상동맥개입술전적혈당급당기화산물수평，료해기여개입치료단기예후적관계。방법련속선취2010년1월지2012년12월우해군총의원주원접수관상동맥개입치료적은정형심교통합병2형당뇨병노년환자188례，근거시부출현결혈병발증여복발심교통、심기경사급사망，장환자분위사건조화대조조；관찰량조심혈관병술전림상위험인소、혈당、당기화산물（당화혈홍단백화당화혈청단백）급고민C반응단백수평적차이，평개각조술전위험인소、당대사급염증반응지표적차이。결과사건조여대조조상비교，년령、성별、체질량지수、흡연사、고혈압급고지혈증발병솔、용약정황이급당화혈홍단백수평차이균무통계학의의（P＞0.05）；공복혈당、당화혈청단백이급고민C반응단백수평명현증고（P＜0.01）；이220μmol/L위계치，당화혈청단백승고환자출현위술기결혈병발증적풍험명현증가（OR＝2.96，95%CI：1.50～5.81，P＝0.001）。결론당기화산물중，술전당화혈청단백수평증고가능시당뇨병합병은정형심교통노년환자관상동맥개입치료위술기결혈병발증적위험예측지표。
Objective To investigate the pre-operative serum levels of glycosylated products in the elderly type 2 diabetes mellitus patients with stable angina undergoing selective percutaneous coronary intervention(PCI), and evaluate the relationship between the levels and short-term outcomes. Methods A total of 188 elderly patients with diabetes and stable angina who were treated with PCI in our hospital from January 2010 to December 2012 were consecutively enrolled in this study. The patients were divided into 2 groups according to onset of post-procedure outcome events, the control group(no event) and the event group(ischemic events: post-procedure angina, myocardial infarction and death). The profiles of clinical cardiovascular risk factors, levels of fasting blood glucose, glycosylated products [glycosylated hemoglobin A1c(HbA1c) and glycosylated serum protein(GSP)] and high sensitivity C reactive protein(hs-CRP) were collected before PCI and compared between 2 groups. Results There was no significant difference in the age, gender, body mass index, history of smoking, incidences of hypertension and hyperlipidemia, medication, and serum HbA1c level between 2 groups(P>0.05). However, the patients in event group had significantly higher levels of fasting blood glucose, GSP and hs-CRP than those in control group(P<0.01). The risk of complicating post-procedure ischemic events in the patients with higher GSP levels(>220μmol/L) was much higher than that in patients having lower GSP levels(OR=2.96, 95%CI=1.50-5.81, P=0.001). Conclusion Elevated GSP level before PCI may be a risk factor of post-procedure ischemic events in the elderly patients with diabetes and stable angina undergoing selective PCI.