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目的:探讨2型糖尿病(DM)患者空腹C肽(FCP)水平对发生冠状动脉(冠脉)疾病(CAD)的影响,为明确FCP与2型DM心血管病变之间的相关性提供理论依据。方法:采用横断面调查方法收集2015-03-2017-03于我院内分泌科住院的单纯2型DM患者及2型DM合并CAD患者615例,记录入选患者一般临床资料及各项实验室检查指标,按照是否合并CAD及病变程度分为单纯糖尿病组(DM组,292例)和合并冠脉轻度病变组(DM+CAD1组,86例)、合并冠脉中度病变组(DM+CAD2组,150例)、合并冠脉重度病变组(DM+CAD3组,87例)。比较各组的FCP水平的差异,多元线性回归分析影响FCP的因素,并利用多分类logistic逐步回归分析探讨不同冠脉病变程度与FCP的关系。结果:2型DM合并冠脉病变患者体内FCP高于单纯DM患者[(0.57±0.32):(0.74±0.56),P<0.05],且随着病变程度的增加,FCP升高显著。双变量相关分析显示FCP与糖化血红蛋白呈负相关(r=-0.256,P=0.000),与体质指数、血尿酸、超敏C反应蛋白、颈动脉内中膜厚度呈正相关(r=0.190,0.219,0.171,0.180,P均为0.000)。多分类logistic回归分析显示,FCP、年龄是DM合并冠脉病变的危险因素,心率是保护因素。结论:FCP水平可以在一定程度上反映应DM合并CAD的发生风险,FCP越高,DM合并CAD的可能越大。
Objective: To investigate the effect of fasting C-peptide (FCP) on coronary artery disease (CAD) in patients with type 2 diabetes mellitus (DM) and to provide a theoretical basis for clarifying the correlation between FCP and type 2 diabetes mellitus . Methods: A total of 615 DM patients with type 2 DM and CAD were enrolled in our hospital from 2015-03-2017-03. The clinical data and laboratory tests of selected patients were recorded (DM group, 292 cases) and mild coronary lesion group (DM + CAD1 group, 86 cases) with moderate coronary artery disease (DM + CAD2 group) , 150 cases), severe coronary artery disease group (DM + CAD3 group, 87 cases). The difference of FCP levels was compared between groups. Multivariate linear regression analysis was used to analyze the factors influencing FCP. Multi-classification logistic stepwise regression analysis was used to explore the relationship between the severity of coronary artery lesions and FCP. Results: The FCP in patients with type 2 diabetes mellitus with coronary artery disease was significantly higher than that in patients with DM [(0.57 ± 0.32) :( 0.74 ± 0.56), P <0.05]. The FCP increased significantly with the severity of DM. Bivariate analysis showed that FCP was negatively correlated with glycosylated hemoglobin (r = -0.256, P = 0.000) and positively correlated with body mass index, serum uric acid, high-sensitivity C-reactive protein and carotid artery intima-media thickness (r = 0.190, , 0.171,0.180, all P <0.000). Multivariate logistic regression analysis showed that FCP and age were the risk factors for DM complicated with coronary artery disease. Heart rate was the protective factor. Conclusion: The level of FCP can reflect the risk of DM with CAD to a certain extent. The higher the FCP, the greater the possibility of DM combined with CAD.