DIABETES CARE:糖尿病患者冠脉狭窄风险明显升高

　　一项最新研究显示，我国早期糖尿病患者中无心肌缺血症状者，其发生冠脉狭窄的风险明显升高。血糖水平是糖尿病患者发生冠脉狭窄的独立危险因素。研究由上海交通大学医学院附属瑞金医院宁光等人进行，2013年3月5日在线发表于《糖尿病护理》（Diabetes Care）杂志。

　　研究旨在评价无心肌缺血症状的中国成年糖尿病患者或糖尿病前期人群的冠脉狭窄风险。研究者从社区居民中随机选取年龄40-60岁的糖调节正常（NGR）、糖尿病前期或5年内确诊糖尿病者，进行双源CT冠脉血管造影并评估其冠脉狭窄发生情况及狭窄程度，所有受试者均无心肌缺血症状。严重狭窄定义为管腔狭窄程度大于50%。

　　经排除不可解释的可归因于运动伪影（motion artifacts）因素，NGR组135名受试者、糖尿病组132名受试者与糖尿病前期组134名受试者纳入数据分析。三组中发生冠脉严重狭窄者分别为10人（7.4%）、10人（7.6%）和22人（16.4%）（P=0.029）。与NGR组受试者相比，糖尿病（而非糖尿病前期）组患者发生冠脉严重狭窄的风险显著升高2.34倍[比值比2.34，（95%可信区间1.01–5.43）;P = 0.047]。

　　血糖水平是糖尿病患者发生冠脉狭窄的独立与显著危险因素。校正其他传统心血管危险因素后，空腹血糖、餐后两小时血糖与糖化血红蛋白（HbA1c）每升高一个标准单位，冠脉严重狭窄发生风险分别增加2.11倍、1.73倍和1.81倍。

与糖尿病相关的拓展阅读：

• Nature：一种小核糖核酸与Ⅱ型糖尿病有关
• Diabetes Care:空气污染诱发糖尿病患者炎症反应
• Diabetes Care：美国糖尿病患者“三达标率”较高
• Diabetes Care：食用红肉使妊娠期糖尿病风险大增
• PLOS ONE：强化降糖或使肥胖糖尿病患者获益
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Significant Coronary Stenosis in Asymptomatic Chinese With Different Glycemic Status

OBJECTIVE 

To evaluate coronary artery stenosis in early diabetes or prediabetes asymptomatic of myocardial ischemia in community-dwelling Chinese adults.

RESEARCH DESIGN AND METHODS 

Age- and sex-matched participants with normal glucose regulation (NGR), prediabetes, or diabetes diagnosed within 5 years, asymptomatic of coronary artery disease (CAD), were randomly selected from a community-dwelling Chinese population aged 40–60 years. Dual-source computed tomography coronary angiography was used to evaluate the existence and extent of coronary stenosis, which was considered significant if >50% narrowing of vessel lumen was detected.

RESULTS 

After excluding uninterpretable segments attributable to motion artifacts, a total of 135 participants with NGR, 132 with prediabetes, and 134 with diabetes participated in data analysis. Significant coronary stenosis was detected in 10 (7.4%), 10 (7.6%), and 22 (16.4%) individuals with NGR, prediabetes, and diabetes, respectively (P for trend = 0.029). Diabetes, rather than prediabetes, was associated with a significant 2.34-fold elevated risk [odds ratio (OR) 2.34 (95% CI 1.01–5.43); P = 0.047] of significant coronary stenosis as compared with that associated with NGR. Levels of glucose evaluation were independently and significantly associated with risks of significant coronary stenosis in diabetes. Each 1-SD increase in fasting plasma glucose, 2-h postload plasma glucose, and HbA1c conveyed 2.11-fold, 1.73-fold, and 1.81-fold higher risks of significant coronary stenosis, respectively, after adjustment for other conventional cardiovascular risk factors.

CONCLUSIONS 

Using a noninvasive CAD diagnostic modality such as dual-source computed tomography coronary angiography, we detected a markedly elevated risk of significant coronary stenosis with early diabetes in asymptomatic Chinese adults.