| Background and Purpose:Diabetes (diabetes mellitus, DM), the prevalence increased year by year, has become aserious hazard to human health, chronic disease with cardiovascular disease and cancer, it iscommon to the three major human epidemic of non-communicable diseases.Type2diabetesmellitus (type2diabetes mellitus T2DM) patients with coronary heart disease risk thannon-diabetic patients is two to four times higher,80%of the patients with T2DM happened ordied of cardiovascular disease and other vascular complications.In recent years, impairedglucose tolerance(IGT) is also considered risk factors for cardiovascular disease as anintermediate state between normal glucose tolerance and diabetes.And a large number ofstudies have shown that impaired glucose tolerance (IGT) stage had lesions of the large bloodvessels[1].But only routine examination of patients with fasting blood glucose in the clinical,which led to the misdiagnosis of diabetes and impaired glucose tolerance in patients withnormal fasting blood glucose.Therefore, this study would explore the influence of Impairedglucose tolerance and the associated risk factors for Coronary artery lesions,by means ofobserving clinical features,laboratory parameters,coronary vessel characteristics (bycoronary angiography and intravascular bounce checks) in patients with coronary heartdisease and different blood glucose levels.Methods:160cases of patients hospitalized in the Department of Cardiology of our hospitaldiagnosed coronary heart disease by coronary angiography (CAG), all patients underwentoral glucose tolerance test (OGTT)(Except for the diabetic group).Patients were divided intothree groups according to different blood glucose levels,namely the diabetic group (DM)54patients (33.8%), impaired glucose tolerance group (IGT)61patients (38.1%) with normalglucose tolerance group (NGT)45patients (28.1%).And right coronary angiography showedcritical lesions of34patients were observed in coronary artery lesions by intravascularultrasound (IVUS), including the DM group,12cases (35.3%), IGT group11cases (32.4%),NGT group11cases(32.4%).Addition, a detailed history, including age, smoking history,drinking history were asked, blood pressure, height, weight,were measured, body massindex was calculated [body mass index=weight (kg)/height2(m2)].Patients afteradmission were baned high-fat diet and strenuous exercise. The next morning they weIrVe diet and strenuous exercise. The next morning they were gotten venous blood measured inserum total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C)and uric acid (UA), fasting plasma glucose (FPG),2-hour postprandial blood sugar(2hPG),glycosylated hemoglobin (HbA1c), the C-reactive protein (CRP). Then clinicaldata,differences in coronary lesions situation among the three groups werecompared;Further the relationship were compared between risk factors of coronary arterydisease and coronary artery lesions in the IGT group，as well as regression analysis of riskfactors.Results:1.Comparison of clinical data:1) Gender, age, smoking history, drinking history, historyof hypertension, body mass index were not statistically significant among three groups (P>0.05);2)laboratory markers: FPG levels of the IGT group and DM group were significantlyhigher than NGT group, the difference was statistically significant (P <0.001)，while therewas no significant differences between the NGT group and IGT group (P>0.05); Comparedwith the IGT group,2hPG levels was higher in the DM group as well as HbA1c (P <0.001);CRP levels of the IGT group and DM group were higher than NGT group (P <0.05), whilethere was no significant differences in CRP levels between the IGT group and DM group((P>0.05).there were no statistically significant differences in other indicators among threegroups.2.Comparison of coronary artery disease among three groups:2.1Results of coronary angiography:2.1.1The differences in the number of diseased vessels: the incidences of single, two,three of coronary lesions in the NGT group were57.8%,15.6%and26.7%respectively. theincidences were3.3%,29.5%and67.2%in the IGT group; while the incidences were7.4%,27.8%and64.8%in the DM group. the incidences of single, two, three of coronary lesionsin IGT and DM groups are gradually increasing, the incidence of single vessel disease inthe NGT group was significantly higher than the DM group and IGT group (both P <0.001),and the incidence of two, three of coronary lesions in the DM group and IGT group wassignificantly higher than the NGT group (both P <0.001),while there were no significantdifferences in the DM group and IGT group (P>0.05).2.1.2The differences in the extent of coronary lesions: the incidences of moderate tosevere stenosis, diffuse disease, total occlusions in the NGT group, were17.8%,8.9%,20.0%respectively; the incidences in the IGT group were82.0%,27.9%,50.8%; the incidences of DM group were100%,31.5%,50.0%.Severe stenosis rate in the DM group was higher thanthat others,Severe stenosis rate in the IGT group was higher than NGT group(all P <0.001);Coronary diffuse lesions rate in the IGT group and DM group was higher than NGT group(both P <0.05),while there were no significant differences in the DM group and IGT group(P>0.05); Coronary occlusion lesions rate in the IGT group and DM group was higher thanNGT group (both P <0.05),while there were no significant differences in the DM group andIGT group (P>0.05).2.1.3Differences in lesion location：Lesions in the LAD branch rates were75.6%,93.4%,94.4%respectively in the NGT group, IGT group, DM group; Lesions in the LCXbranch rates were37.8%,78.7%,75.9%respectively；Lesions in the RCA branch rates were62.2%,86.9%,88.9%respectively；Lesions in the LMA branch rates were0%,9.8%,3.7%respectively.The disease incidence of LAD、LCX and RCA in the DM group and IGT groupwere higher than NGT group (all P <0.01), but there were no significant differences in theDM group and IGT group (P>0.05).The disease incidence of LMA had no significantdifferences among the three groups (all P>0.05).2.2Comparison of the results of intravascular ultrasound：the incidences of unstableplaque were54.5%,63.6%,75.0%respectively in the NGT group, IGT group, DM group，there were no significant difference in plaque stability among three groups (P>0.05);theincidences of eccentric plaque were63.6%,54.5%,75.0%respectively，there were nosignificant difference in plaque eccentricity among three groups (P>0.05)；There were nosignificant difference in Plaque calcification among three groups (P>0.05).3.The relationship between coronary artery lesions and risk factors in the IGT group3.1. Coronary lesion count and Risk Factors:The results showed: HbA1c and2hPG intwo and three-vessel disease patients were higher than in patients with a lesion, thedifference was statistically significant (both P <0.05).3.2.the extent of coronary lesions and risk factors:The results showed: Compared topatients with mild coronary artery stenosis, the TC、FPG and HbA1c in patients with severecoronary artery stenosis were higher (all P <0.05); compared with patients with narrowlimitations lesions, LDL-C and FPG in patients with diffuse lesions were higher(both P<0.05); CRP levels in patients with occlusive stenosis was higher than patients withnon-occlusive lesions (P <0.05).3.3coronary artery lesions location and risk factors：The results showed: TC, LDL-C and HbA1c levels in patients with LAD lesions were higher than that others (all P<0.05);Risk factors had no significant difference between RCA lesion and non-RCA lesion;HbA1c levels in the patients with LCX lesions was higher than that others (P <0.05); CRPlevels in patients with LMA lesions was higher (P <0.05).4.Analysis of coronary heart disease risk factors:Logistic regression analysis showedthat impaired glucose tolerance, diabetes were independent risk factor for three diseasecoronary artery; Diabetes were independent risk factor for diffuse disease; IGT, DM,HbA1c, CRP were independent risk factor for moderate to severe coronary lesions.Conclusion:1.Coronary artery disease maybe a serious, branch, occlusion and diffuse lesions,whencoronary heart disease combined with type2diabetes.2.Coronary artery had severe lesions which showed multiple branch, occlusion, diffusedisease, and the same distribution of lesions as type2diabetes,when coronary heart diseasecombined with impaired glucose tolerance.3.Different blood glucose, blood lipid and C-reactive protein levels were not only relatedto the degree of coronary lesions but also to vascular lesions.4.Impaired glucose tolerance was independent risk factor for occlusive lesions, severecoronary lesions and triple-vessel disease. |
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