【摘要】 目的 探讨不同糖代谢状态下老年冠心病(CAD)患者冠状动脉病变的范围及严重程度。方法 比较不同糖代谢状态组在临床生化指标、狭窄冠状动脉支数、冠状动脉狭窄严重程度积分等方面的差别。 结果 糖代谢异常(IGR)组和DM组的高敏C反应蛋白(hsC-RP)和胰岛素抵抗指数(HOMA-IR)均高于糖代谢正常(NGT)组(P<0.05)。狭窄冠状动脉支数、Gensini积分与hsC-RP、HOMA-IR均呈正相关(P<0.05)。IGR组及DM组受累冠状动脉支数明显多于NGT组(P<0.01)，Gensini积分亦明显高于NGT组(P<0.001)。DM组复杂病变的发生率明显高于NGT组(P=0.004)，其3支病变的发生率亦均高于NGT组及IGR组(P<0.05)。 结论 IGR及DM均可加重老年CAD患者冠状动脉病变的范围及严重程度。

　　【关键词】 糖代谢状态;冠心病;高敏C反应蛋白;胰岛素抵抗指数

　　Influence of different glycometabolic conditions on pathological changes of coronary artery in elderly patients with coronary heart disease ZHAO Ya-jie, SHEN Lin-hui, ZHAO Yong-ju, et al. Department of Geriatrics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China

　　Corresponding author: ZHAO Yong-ju, E-mail: yongju1220@medmail.com.cn

　　【Abstract】Objective To investigate the influence of different glycometabolic conditions on the pathological changes of coronary artery in elderly patients with coronary arterosclerosis disease (CAD). Methods The biochemical parameters, severity of coronary artery stenosis and Gensini scores of the elderly CAD patients in different glycometabolic conditions were compared to observe the differences. Results High sensitivity C-reactive protein (hs C-RP) and homeostasis model assessment of insulin resistance (HOMA-IR) were higher in the impaired glucose regulation (IGR) group and the diabetes mellitus (DM) group than in the normal glucose tolerance (NGT) group (P<0.05). The severity of coronary artery stenosis and Gensini scores were positively associated with hs C-RP and HOMA-IR (P<0.05). The severity of coronary artery stenosis and Gensini scores were much higher in the IGR group and the DM group than in the NGT group (P<0.01). The prevalence of complex lesions and the triple vessel involvement were significantly higher in the DM group than in the NGT group and the IGR group (P<0.05). Conclusion Either IGR or DM may accelerate the pathological changes of coronary artery in elderly CAD patients. Glycemic control, insulin resistance, and inflammation improvement may help to prevent severe cardiovascular events in this population.

　　【Key words】Glycometabolic state; Coronary heart disease; High sensitivity C-reactive protein; Homeostasis model assessment of insulin resistance